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Bashi AC, Coker EA, Bulusu KC, Jaaks P, Crafter C, Lightfoot H, Milo M, McCarten K, Jenkins DF, van der Meer D, Lynch JT, Barthorpe S, Andersen CL, Barry ST, Beck A, Cidado J, Gordon JA, Hall C, Hall J, Mali I, Mironenko T, Mongeon K, Morris J, Richardson L, Smith PD, Tavana O, Tolley C, Thomas F, Willis BS, Yang W, O'Connor MJ, McDermott U, Critchlow SE, Drew L, Fawell SE, Mettetal JT, Garnett MJ. Large-scale Pan-cancer Cell Line Screening Identifies Actionable and Effective Drug Combinations. Cancer Discov 2024; 14:846-865. [PMID: 38456804 PMCID: PMC11061612 DOI: 10.1158/2159-8290.cd-23-0388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 11/01/2023] [Accepted: 02/02/2024] [Indexed: 03/09/2024]
Abstract
Oncology drug combinations can improve therapeutic responses and increase treatment options for patients. The number of possible combinations is vast and responses can be context-specific. Systematic screens can identify clinically relevant, actionable combinations in defined patient subtypes. We present data for 109 anticancer drug combinations from AstraZeneca's oncology small molecule portfolio screened in 755 pan-cancer cell lines. Combinations were screened in a 7 × 7 concentration matrix, with more than 4 million measurements of sensitivity, producing an exceptionally data-rich resource. We implement a new approach using combination Emax (viability effect) and highest single agent (HSA) to assess combination benefit. We designed a clinical translatability workflow to identify combinations with clearly defined patient populations, rationale for tolerability based on tumor type and combination-specific "emergent" biomarkers, and exposures relevant to clinical doses. We describe three actionable combinations in defined cancer types, confirmed in vitro and in vivo, with a focus on hematologic cancers and apoptotic targets. SIGNIFICANCE We present the largest cancer drug combination screen published to date with 7 × 7 concentration response matrices for 109 combinations in more than 750 cell lines, complemented by multi-omics predictors of response and identification of "emergent" combination biomarkers. We prioritize hits to optimize clinical translatability, and experimentally validate novel combination hypotheses. This article is featured in Selected Articles from This Issue, p. 695.
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Affiliation(s)
| | | | | | | | | | | | - Marta Milo
- Oncology R&D, AstraZeneca, Cambridge, United Kingdom
| | | | | | | | | | - Syd Barthorpe
- Wellcome Sanger Institute, Cambridge, United Kingdom
| | | | | | | | | | | | - Caitlin Hall
- Wellcome Sanger Institute, Cambridge, United Kingdom
| | - James Hall
- Wellcome Sanger Institute, Cambridge, United Kingdom
| | - Iman Mali
- Wellcome Sanger Institute, Cambridge, United Kingdom
| | | | | | - James Morris
- Wellcome Sanger Institute, Cambridge, United Kingdom
| | | | - Paul D. Smith
- Oncology R&D, AstraZeneca, Cambridge, United Kingdom
| | - Omid Tavana
- Oncology R&D, AstraZeneca, Waltham, Massachusetts
| | | | | | | | - Wanjuan Yang
- Wellcome Sanger Institute, Cambridge, United Kingdom
| | | | | | | | - Lisa Drew
- Oncology R&D, AstraZeneca, Waltham, Massachusetts
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Grazini U, Markovets A, Ireland L, O'Neill D, Phillips B, Xu M, Pfeifer M, Vaclova T, Martin MJ, Bigot L, Friboulet L, Hartmaier R, Cuomo ME, Barry ST, Smith PD, Floc'h N. Overcoming osimertinib resistance with AKT inhibition in EGFRm-driven Non-Small-Cell-Lung-Cancer with PIK3CA/PTEN alterations. Clin Cancer Res 2024:743076. [PMID: 38630555 DOI: 10.1158/1078-0432.ccr-23-2540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/31/2023] [Accepted: 04/05/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE Osimertinib is an epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) indicated for the treatment of EGFR mutated (EGFRm)-driven lung adenocarcinomas. Osimertinib significantly improves progression-free survival in first-line treated patients with EGFRm advanced NSCLC. Despite the durable disease control, the majority of patients receiving osimertinib eventually develop disease progression. EXPERIMENTAL DESIGN ctDNA profiling analysis on-progression plasma samples from patients treated with osimertinib in both first (Phase 3, FLAURA trial) and second-line trials (Phase 3, AURA3 trial) revealed a high prevalence of PIK3CA/AKT/PTEN alterations. In vitro and in vivo evidence using CRISPR engineered NSCLC cell lines and PXD models support a functional role for PIK3CA and PTEN mutations in the development of osimertinib resistance. RESULTS These alterations are functionally relevant as EGFRm NSCLC cells with engineered PIK3CA/AKT/PTEN alterations develop resistance to osimertinib and can be re-sensitized by treatment with the combination of osimertinib and the AKT inhibitor capivasertib. Moreover, xenograft and PDX in vivo models with PIK3CA/AKT/PTEN alterations display limited sensitivity to osimertinib relative to models without alteration, and in these double mutant models capivasertib and osimertinib combination elicits an improved anti-tumor effect versus osimertinib alone. CONCLUSIONS Together, this approach offers a potential treatment strategy for patients with EGFRm-driven NSCLC that have a sub-optimal response, or develop resistance, to osimertinib through PIK3CA/AKT/PTEN alterations.
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Affiliation(s)
| | | | - Lucy Ireland
- AstraZeneca (United Kingdom), Cambridge, United Kingdom
| | | | | | - Man Xu
- AstraZeneca (United States), Boston, MA, United States
| | | | - Tereza Vaclova
- AstraZeneca (United Kingdom), CAMBRIDGE, None, United Kingdom
| | | | | | | | | | | | - Simon T Barry
- AstraZeneca (United Kingdom), Cambridge, United Kingdom
| | - Paul D Smith
- AstraZeneca (United Kingdom), Cambridge, Cambridgeshire, United Kingdom
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Nasra M, Maingard JT, Hall J, Mitreski G, Kuan Kok H, Smith PD, Russell JH, Jhamb A, Brooks DM, Asadi H. Clipping versus coiling: A critical re-examination of a decades old controversy. Interv Neuroradiol 2024; 30:86-93. [PMID: 36017537 PMCID: PMC10956463 DOI: 10.1177/15910199221122854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 08/10/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Two major studies, The International Subarachnoid Aneurysm Trial and the Barrow Ruptured Aneurysm Trial, compare the long-term outcomes of clipping and coiling. Although these demonstrated coiling's initial benefits, rebleeding and retreatment rates as well as converging patient outcomes sparked controversy regarding its durability. This article will critically examine the available evidence for and against clipping and coiling of intracranial aneurysms. Critics of endovascular treatment state that the initial benefit seen with endovascular coiling decreases over the duration of follow-up and eventually functional outcomes of both treatment modalities are similar. Combined with the increased rate of retreatment and rebleeding, these trials reveal that coiling is not as durable and not as effective as a long-term treatment compared to clipping. Also, due to the cost of devices following endovascular treatment and prolonged hospitalization following clipping, the financial burden has been considered controversial. SUMMARY/KEY MESSAGES Short-term outcomes reveal better morbidity and mortality outcomes following coiling. Despite the higher rates of retreatment and rebleeding with coiling, there was no significant change in functional outcomes following retreatment. Furthermore, examining more recent trials reveals a decreased rate of recurrence and rebleeding with improved technology and expertise. Functional outcomes deteriorate for both cohorts over time while recent results revealed improved long-term cognitive outcomes and levels of health-related quality of life after coiling in comparison to clipping. The expense of longer hospital stays following clipping must be balanced against the expense of endovascular devices in coiling.
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Affiliation(s)
| | - Julian Tam Maingard
- Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Clayton, Victoria, Australia
- Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- Department of Radiology, Interventional Neuroradiology Service, Austin Health, Heidelberg, Victoria, Australia
| | - Jonathan Hall
- Department of Interventional Radiology, St Vincent's Health Australia, Fitzroy, Victoria, Australia
| | - Goran Mitreski
- Department of Radiology, Interventional Neuroradiology Service, Austin Health, Heidelberg, Victoria, Australia
| | - Hong Kuan Kok
- Interventional Radiology Service, Northern Hospital, Epping, Victoria, Australia
| | - Paul D. Smith
- Department of Neurosurgery, St Vincent's Hospital, Fitzroy, Victoria, Melbourne, Australia
- Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - Jeremy H. Russell
- Department of Neurosurgery, Austin Health, Heidelberg, Victoria, Australia
| | - Ashu Jhamb
- Department of Interventional Radiology, St Vincent's Health Australia, Fitzroy, Victoria, Australia
| | - Duncan Mark Brooks
- Department of Radiology, Interventional Neuroradiology Service, Austin Health, Heidelberg, Victoria, Australia
- School of Medicine-Faculty of Health, Deakin University, Waurn Ponds, Victoria, Australia
| | - Hamed Asadi
- Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Clayton, Victoria, Australia
- Department of Radiology, Interventional Neuroradiology Service, Austin Health, Heidelberg, Victoria, Australia
- School of Medicine-Faculty of Health, Deakin University, Waurn Ponds, Victoria, Australia
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
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Stevens ER, Agbakoba R, Mann DM, Hess R, Richardson SI, McGinn T, Smith PD, Halm W, Mundt MP, Dauber-Decker KL, Jones SA, Feldthouse DM, Kim EJ, Feldstein DA. Reducing prescribing of antibiotics for acute respiratory infections using a frontline nurse-led EHR-Integrated clinical decision support tool: protocol for a stepped wedge randomized control trial. BMC Med Inform Decis Mak 2023; 23:260. [PMID: 37964232 PMCID: PMC10644670 DOI: 10.1186/s12911-023-02368-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 11/06/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Overprescribing of antibiotics for acute respiratory infections (ARIs) remains a major issue in outpatient settings. Use of clinical prediction rules (CPRs) can reduce inappropriate antibiotic prescribing but they remain underutilized by physicians and advanced practice providers. A registered nurse (RN)-led model of an electronic health record-integrated CPR (iCPR) for low-acuity ARIs may be an effective alternative to address the barriers to a physician-driven model. METHODS Following qualitative usability testing, we will conduct a stepped-wedge practice-level cluster randomized controlled trial (RCT) examining the effect of iCPR-guided RN care for low acuity patients with ARI. The primary hypothesis to be tested is: Implementation of RN-led iCPR tools will reduce antibiotic prescribing across diverse primary care settings. Specifically, this study aims to: (1) determine the impact of iCPRs on rapid strep test and chest x-ray ordering and antibiotic prescribing rates when used by RNs; (2) examine resource use patterns and cost-effectiveness of RN visits across diverse clinical settings; (3) determine the impact of iCPR-guided care on patient satisfaction; and (4) ascertain the effect of the intervention on RN and physician burnout. DISCUSSION This study represents an innovative approach to using an iCPR model led by RNs and specifically designed to address inappropriate antibiotic prescribing. This study has the potential to provide guidance on the effectiveness of delegating care of low-acuity patients with ARIs to RNs to increase use of iCPRs and reduce antibiotic overprescribing for ARIs in outpatient settings. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04255303, Registered February 5 2020, https://clinicaltrials.gov/ct2/show/NCT04255303 .
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Affiliation(s)
| | | | - Devin M Mann
- NYU Grossman School of Medicine, New York, NY, USA
| | - Rachel Hess
- University of Utah Health, Salt Lake City, UT, USA
| | | | | | - Paul D Smith
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Wendy Halm
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- University of Wisconsin School of Nursing, Madison, WI, USA
| | - Marlon P Mundt
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | | | | | - Eun Ji Kim
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
- Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - David A Feldstein
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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Bertran-Alamillo J, Giménez-Capitán A, Román R, Talbot S, Whiteley R, Floc'h N, Martínez-Pérez E, Martin MJ, Smith PD, Sullivan I, Terp MG, Saeh J, Marino-Buslje C, Fabbri G, Guo G, Xu M, Tornador C, Aguilar-Hernández A, Reguart N, Ditzel HJ, Martínez-Bueno A, Nabau-Moretó N, Gascó A, Rosell R, Pease JE, Polanska UM, Travers J, Urosevic J, Molina-Vila MA. BID expression determines the apoptotic fate of cancer cells after abrogation of the spindle assembly checkpoint by AURKB or TTK inhibitors. Mol Cancer 2023; 22:110. [PMID: 37443114 PMCID: PMC10339641 DOI: 10.1186/s12943-023-01815-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Drugs targeting the spindle assembly checkpoint (SAC), such as inhibitors of Aurora kinase B (AURKB) and dual specific protein kinase TTK, are in different stages of clinical development. However, cell response to SAC abrogation is poorly understood and there are no markers for patient selection. METHODS A panel of 53 tumor cell lines of different origins was used. The effects of drugs were analyzed by MTT and flow cytometry. Copy number status was determined by FISH and Q-PCR; mRNA expression by nCounter and RT-Q-PCR and protein expression by Western blotting. CRISPR-Cas9 technology was used for gene knock-out (KO) and a doxycycline-inducible pTRIPZ vector for ectopic expression. Finally, in vivo experiments were performed by implanting cultured cells or fragments of tumors into immunodeficient mice. RESULTS Tumor cells and patient-derived xenografts (PDXs) sensitive to AURKB and TTK inhibitors consistently showed high expression levels of BH3-interacting domain death agonist (BID), while cell lines and PDXs with low BID were uniformly resistant. Gene silencing rendered BID-overexpressing cells insensitive to SAC abrogation while ectopic BID expression in BID-low cells significantly increased sensitivity. SAC abrogation induced activation of CASP-2, leading to cleavage of CASP-3 and extensive cell death only in presence of high levels of BID. Finally, a prevalence study revealed high BID mRNA in 6% of human solid tumors. CONCLUSIONS The fate of tumor cells after SAC abrogation is driven by an AURKB/ CASP-2 signaling mechanism, regulated by BID levels. Our results pave the way to clinically explore SAC-targeting drugs in tumors with high BID expression.
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Affiliation(s)
- Jordi Bertran-Alamillo
- Laboratory of Oncology, Pangaea Oncology, Quiron Dexeus University Hospital, C/ Sabino Arana 5-19, 08913, Barcelona, Spain
| | - Ana Giménez-Capitán
- Laboratory of Oncology, Pangaea Oncology, Quiron Dexeus University Hospital, C/ Sabino Arana 5-19, 08913, Barcelona, Spain
| | - Ruth Román
- Laboratory of Oncology, Pangaea Oncology, Quiron Dexeus University Hospital, C/ Sabino Arana 5-19, 08913, Barcelona, Spain
| | - Sara Talbot
- Bioscience, Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, CB21 6GH, UK
| | - Rebecca Whiteley
- Bioscience, Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, CB21 6GH, UK
| | - Nicolas Floc'h
- Bioscience, Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, CB21 6GH, UK
| | | | - Matthew J Martin
- Bioscience, Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, CB21 6GH, UK
| | - Paul D Smith
- Bioscience, Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, CB21 6GH, UK
| | - Ivana Sullivan
- Servicio de Oncología Médica, Hospital de la Santa Creu i Sant Pau, Barcelona, 08025, Spain
- Instituto Oncológico Dr. Rosell, Hospital Universitario Dexeus, Barcelona, 08028, Spain
| | - Mikkel G Terp
- Department of Cancer and Inflammation Research, Institute of Molecular Medicine, University of Southern Denmark, Odense C, 5000, Denmark
| | - Jamal Saeh
- Bioscience, Research and Early Development, Oncology R&D, AstraZeneca, Waltham, MA, 02451, USA
| | | | - Giulia Fabbri
- Translational Medicine, Research and Early Development, Oncology R&D, AstraZeneca, Waltham, MA, 02451, USA
| | - Grace Guo
- Bioscience, Research and Early Development, Oncology R&D, AstraZeneca, Waltham, MA, 02451, USA
| | - Man Xu
- Bioscience, Research and Early Development, Oncology R&D, AstraZeneca, Waltham, MA, 02451, USA
| | | | | | - Noemí Reguart
- Thoracic Oncology Unit, Department of Medical Oncology, Hospital Clínic, Barcelona, 08036, Spain
| | - Henrik J Ditzel
- Department of Cancer and Inflammation Research, Institute of Molecular Medicine, University of Southern Denmark, Odense C, 5000, Denmark
- Department of Oncology, Odense University Hospital, Odense, 5000, Denmark
| | | | | | - Amaya Gascó
- Bioscience, Research and Early Development, Oncology R&D, AstraZeneca, Gaithersburg, MD, 20878, USA
| | - Rafael Rosell
- Instituto Oncológico Dr. Rosell, Hospital Universitario Dexeus, Barcelona, 08028, Spain
- Germans Trias i Pujol Research Institute (IGTP), Badalona, 08916, Spain
| | - J Elizabeth Pease
- Bioscience, Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, CB21 6GH, UK
| | - Urszula M Polanska
- Bioscience, Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, CB21 6GH, UK
| | - Jon Travers
- Bioscience, Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, CB21 6GH, UK
| | - Jelena Urosevic
- Bioscience, Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, CB21 6GH, UK.
| | - Miguel A Molina-Vila
- Laboratory of Oncology, Pangaea Oncology, Quiron Dexeus University Hospital, C/ Sabino Arana 5-19, 08913, Barcelona, Spain.
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6
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Young HN, Pathan FS, Hudson S, Mott D, Smith PD, Schellhase KG. Impact of patient-centered prescription medication labels on adherence in community pharmacy. J Am Pharm Assoc (2003) 2023; 63:785-792. [PMID: 36725425 DOI: 10.1016/j.japh.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 12/14/2022] [Accepted: 01/05/2023] [Indexed: 01/11/2023]
Abstract
BACKGROUND Prescription medication labels are often constructed in a manner which hinders safe and appropriate use of medicines. The United States Pharmacopeia released voluntary standards to revise medication labels in an effort to support patients' understanding and improve medication use. OBJECTIVE To examine the impact of label changes on medication adherence before and after pharmacy implementation of the United States Pharmacopeia patient-centered prescription medication label standards. METHODS This study used a retrospective pre-post cohort design. Prescription fill claims data were obtained from a community health plan serving Medicaid patients for 1 independent community pharmacy organization across 8 retail pharmacy sites. We calculated medication possession ratios (MPR) and proportion of days covered (PDC) for medications used for contraception, asthma, hypertension, and depression from 15 months before to 13 months after implementation of the label changes. RESULTS Findings showed significant increases in mean MPR for asthma controller (increased by 0.111 [t = 0.290, P<0.0001]), antihypertensives (increased by 0.062 [t = 0.146, P < 0.0002]), and contraceptives medications (increased 0.133 [t = 0.209, P < 0.0001]) from preintervention to postintervention periods. Results also revealed increases in mean PDC for asthma controllers (increased by 0.193 [t = 0.267, P < 0.0001]), antihypertensives (increased by 0.067 [t = 0.175, P = 0.049]), and contraceptives (increased by 0.111 [t = 0.208, P < 0.0119]) from preintervention to postintervention periods. CONCLUSION We report an association between a change to more patient-centered prescription medication labels and increased medication adherence based on MPR and PDC among Medicaid recipients.
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7
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Criscione SW, Martin MJ, Oien DB, Gorthi A, Miragaia RJ, Zhang J, Chen H, Karl DL, Mendler K, Markovets A, Gagrica S, Delpuech O, Dry JR, Grondine M, Hattersley MM, Urosevic J, Floc’h N, Drew L, Yao Y, Smith PD. The landscape of therapeutic vulnerabilities in EGFR inhibitor osimertinib drug tolerant persister cells. NPJ Precis Oncol 2022; 6:95. [PMID: 36575215 PMCID: PMC9794691 DOI: 10.1038/s41698-022-00337-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 12/12/2022] [Indexed: 12/28/2022] Open
Abstract
Third-generation EGFR tyrosine kinase inhibitors (EGFR-TKIs), including osimertinib, an irreversible EGFR-TKI, are important treatments for non-small cell lung cancer with EGFR-TKI sensitizing or EGFR T790M resistance mutations. While patients treated with osimertinib show clinical benefit, disease progression and drug resistance are common. Emergence of de novo acquired resistance from a drug tolerant persister (DTP) cell population is one mechanism proposed to explain progression on osimertinib and other targeted cancer therapies. Here we profiled osimertinib DTPs using RNA-seq and ATAC-seq to characterize the features of these cells and performed drug screens to identify therapeutic vulnerabilities. We identified several vulnerabilities in osimertinib DTPs that were common across models, including sensitivity to MEK, AURKB, BRD4, and TEAD inhibition. We linked several of these vulnerabilities to gene regulatory changes, for example, TEAD vulnerability was consistent with evidence of Hippo pathway turning off in osimertinib DTPs. Last, we used genetic approaches using siRNA knockdown or CRISPR knockout to validate AURKB, BRD4, and TEAD as the direct targets responsible for the vulnerabilities observed in the drug screen.
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Affiliation(s)
- Steven W. Criscione
- grid.418152.b0000 0004 0543 9493Research and Early Development, Oncology R&D, AstraZeneca, Boston, MA USA
| | - Matthew J. Martin
- grid.417815.e0000 0004 5929 4381Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, UK
| | - Derek B. Oien
- grid.418152.b0000 0004 0543 9493Research and Early Development, Oncology R&D, AstraZeneca, Boston, MA USA
| | - Aparna Gorthi
- grid.418152.b0000 0004 0543 9493Research and Early Development, Oncology R&D, AstraZeneca, Boston, MA USA ,grid.267309.90000 0001 0629 5880Department of Cell Systems & Anatomy, Greehey Children’s Cancer Research Institute, University of Texas at Health San Antonio, San Antonio, TX USA
| | - Ricardo J. Miragaia
- grid.417815.e0000 0004 5929 4381Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, UK
| | - Jingwen Zhang
- grid.418152.b0000 0004 0543 9493Research and Early Development, Oncology R&D, AstraZeneca, Boston, MA USA
| | - Huawei Chen
- grid.418152.b0000 0004 0543 9493Research and Early Development, Oncology R&D, AstraZeneca, Boston, MA USA
| | - Daniel L. Karl
- grid.418152.b0000 0004 0543 9493Research and Early Development, Oncology R&D, AstraZeneca, Boston, MA USA
| | - Kerrin Mendler
- grid.418152.b0000 0004 0543 9493Research and Early Development, Oncology R&D, AstraZeneca, Boston, MA USA
| | - Aleksandra Markovets
- grid.418152.b0000 0004 0543 9493Research and Early Development, Oncology R&D, AstraZeneca, Boston, MA USA
| | - Sladjana Gagrica
- grid.417815.e0000 0004 5929 4381Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, UK
| | - Oona Delpuech
- grid.417815.e0000 0004 5929 4381Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, UK
| | - Jonathan R. Dry
- grid.418152.b0000 0004 0543 9493Research and Early Development, Oncology R&D, AstraZeneca, Boston, MA USA
| | - Michael Grondine
- grid.418152.b0000 0004 0543 9493Research and Early Development, Oncology R&D, AstraZeneca, Boston, MA USA
| | - Maureen M. Hattersley
- grid.418152.b0000 0004 0543 9493Research and Early Development, Oncology R&D, AstraZeneca, Boston, MA USA
| | - Jelena Urosevic
- grid.417815.e0000 0004 5929 4381Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, UK
| | - Nicolas Floc’h
- grid.417815.e0000 0004 5929 4381Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, UK
| | - Lisa Drew
- grid.418152.b0000 0004 0543 9493Research and Early Development, Oncology R&D, AstraZeneca, Boston, MA USA
| | - Yi Yao
- grid.418152.b0000 0004 0543 9493Research and Early Development, Oncology R&D, AstraZeneca, Boston, MA USA
| | - Paul D. Smith
- grid.417815.e0000 0004 5929 4381Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, UK
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8
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Nasra M, Weerakkody D, Maingard JT, Hall J, Mitreski G, Kok HK, Smith PD, Russell JH, Jhamb A, Brooks DM, Asadi H. A Systematic Review of Neuropsychological Outcomes After Treatment of Intracranial Aneurysms. Neurosurgery 2022; 91:831-841. [PMID: 36239513 DOI: 10.1227/neu.0000000000002147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/12/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Aneurysmal subarachnoid hemorrhage is a cause of profound morbidity and mortality. Its effects extend beyond functional neurological status to neurocognitive and psychological functioning. Endovascular treatment is becoming more prevalent after increasing evidence for its safety and efficacy; however, there is a relative paucity of evidence specific to neurocognitive status after treatment. OBJECTIVE To assess and compare neuropsychological outcomes after the treatment of ruptured and unruptured intracranial aneurysms. METHODS A systematic review of the literature was conducted searching for articles assessing the neuropsychological and cognitive outcomes after the treatment of ruptured and unruptured intracranial aneurysms. Inclusion criteria were English language, publication between January 2000 and October 2020, and discussion of neuropsychological outcomes in adequate detail. Outcomes were categorized into 8 domains: 5 Neurocognitive (Language, Executive Function, Complex Attention, Memory and Learning, and Perceptual motor function), Intelligence Quotient, Affect, and Quality of Life. RESULTS Twenty-four articles were included comprising 2236 patients (924 surgical clipping, 1095 endovascular coiling, and 217 controls). These studies reported that most tests revealed no significant difference [n = 356/421 (84.56%)] between treatment modalities. More studies reported significantly superior test scores in the fields of language, executive function, and memory and learning after coiling [n = 53/421 tests (12.59%)] compared with clipping [n = 12/421 tests (2.85%)]. CONCLUSION The current available data and published studies demonstrate a trend toward improved neurocognitive and psychological outcomes after endovascular treatment. Although these findings should be considered when deciding on the optimal treatment method for each patient, drawing definitive conclusions is difficult because of heterogeneity between patients and studies.
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Affiliation(s)
| | | | - Julian Tam Maingard
- Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Clayton, Victoria, Australia.,Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.,Department of Radiology, Interventional Neuroradiology Service, Austin Health, Heidelberg, Australia.,Department of Interventional Radiology, St Vincent's Health Australia, Fitzroy, Victoria, Australia
| | - Jonathan Hall
- Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.,Department of Interventional Radiology, St Vincent's Health Australia, Fitzroy, Victoria, Australia
| | - Goran Mitreski
- Department of Radiology, Interventional Neuroradiology Service, Austin Health, Heidelberg, Australia
| | - Hong Kuan Kok
- Interventional Radiology Service, Northern Health, Epping, Victoria, Australia
| | - Paul D Smith
- Department of Neurosurgery, St Vincent's Hospital, Fitzroy, Victoria, Melbourne, Australia.,Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Melbourne
| | - Jeremy H Russell
- Department of Neurosurgery, Austin Health, Heidelberg, Victoria, Australia
| | - Ashu Jhamb
- Department of Interventional Radiology, St Vincent's Health Australia, Fitzroy, Victoria, Australia
| | - Duncan Mark Brooks
- Department of Radiology, Interventional Neuroradiology Service, Austin Health, Heidelberg, Australia.,School of Medicine-Faculty of Health, Deakin University, Waurn Ponds, Victoria, Australia
| | - Hamed Asadi
- Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Clayton, Victoria, Australia.,Department of Radiology, Interventional Neuroradiology Service, Austin Health, Heidelberg, Australia.,School of Medicine-Faculty of Health, Deakin University, Waurn Ponds, Victoria, Australia.,Stroke Division, Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
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9
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Channathodiyil P, May K, Segonds-Pichon A, Smith PD, Cook S, Houseley J. Escape from G1 arrest during acute MEK inhibition drives the acquisition of drug resistance. NAR Cancer 2022; 4:zcac032. [PMID: 36267209 PMCID: PMC9575185 DOI: 10.1093/narcan/zcac032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 09/08/2022] [Accepted: 10/04/2022] [Indexed: 11/13/2022] Open
Abstract
Mutations and gene amplifications that confer drug resistance emerge frequently during chemotherapy, but their mechanism and timing are poorly understood. Here, we investigate BRAFV600E amplification events that underlie resistance to the MEK inhibitor selumetinib (AZD6244/ARRY-142886) in COLO205 cells, a well-characterized model for reproducible emergence of drug resistance, and show that BRAF amplifications acquired de novo are the primary cause of resistance. Selumetinib causes long-term G1 arrest accompanied by reduced expression of DNA replication and repair genes, but cells stochastically re-enter the cell cycle during treatment despite continued repression of pERK1/2. Most DNA replication and repair genes are re-expressed as cells enter S and G2; however, mRNAs encoding a subset of factors important for error-free replication and chromosome segregation, including TIPIN, PLK2 and PLK3, remain at low abundance. This suggests that DNA replication following escape from G1 arrest in drug is more error prone and provides a potential explanation for the DNA damage observed under long-term RAF-MEK-ERK1/2 pathway inhibition. To test the hypothesis that escape from G1 arrest in drug promotes de novo BRAF amplification, we exploited the combination of palbociclib and selumetinib. Combined treatment with selumetinib and a dose of palbociclib sufficient to reinforce G1 arrest in selumetinib-sensitive cells, but not to impair proliferation of resistant cells, delays the emergence of resistant colonies, meaning that escape from G1 arrest is critical in the formation of resistant clones. Our findings demonstrate that acquisition of MEK inhibitor resistance often occurs through de novo gene amplification and can be suppressed by impeding cell cycle entry in drug.
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Affiliation(s)
| | - Kieron May
- Epigenetics Programme, Babraham Institute, Cambridge, CB22 4NT, UK
| | | | - Paul D Smith
- Oncology R&D, AstraZeneca CRUK Cambridge Institute, Cambridge, CB2 0AA, UK
| | - Simon J Cook
- Signalling Programme, Babraham Institute, Cambridge, CB22 4NT, UK
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10
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Fierro CM, Smith PD, Light ME. Structure of a dinickel(II)-dithiolate bridged macrocyclic complex synthesised via a novel solvent-assisted disulfide cleavage reaction. Polyhedron 2022. [DOI: 10.1016/j.poly.2022.116222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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11
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Martin MJ, Floc'h N, Pfeifer M, Criscione S, Delpuech O, Gagrica S, Yao Y, McDermott U, Smith PD. Pharmaceutical reactivation of attenuated apoptotic pathways leads to elimination of osimertinib drug tolerant cells. Cancer Research Communications 2022; 2:1312-1325. [PMID: 36969743 PMCID: PMC10035388 DOI: 10.1158/2767-9764.crc-22-0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/07/2022] [Accepted: 09/08/2022] [Indexed: 11/16/2022]
Abstract
Abstract
Osimertinib is an EGFR tyrosine kinase inhibitor (TKI) with proven clinical efficacy, however acquired resistance presents an obstacle to curing EGFR-driven disease. Recent studies have shown that drug-tolerant persister cells (DTPs)have a distinct transcriptional profile that may confer specific vulnerabilities. By definition these cells avoid apoptosis, yet little is known about how their survival is regulated. We found that paradoxically, the pro-apoptotic gene BIM was upregulated in osimertinib DTPs, and co-treatment with BH3 mimetics could trigger DTP cell death. Further, cIAP proteins, anti-apoptotic members of the extrinsic pathway, were significantly elevated in DTPs. cIAP antagonists could block DTP formation as an up-front combination, and could eliminate pre-formed DTPs. Critically, when treated at the time of maximal osimertinib response, cIAP or MCL1 inhibitor treatment could significantly attenuate the regrowth of EGFRm cell line mouse xenografts. Finally, we show that apoptosis can be maximized in cell lines with acquired osimertinib resistance by combining BH3 or SMAC mimetics with agents that target the resistance driver in these models. Taken together, these data suggest novel therapeutic strategies at the point of minimal residual disease or full osimertinib resistance for patients in this critical area of unmet need.
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Affiliation(s)
| | | | | | | | | | | | - Yi Yao
- AstraZeneca R&D Boston, Waltham, United States
| | | | - Paul D. Smith
- AstraZeneca (United Kingdom), Cambridge, Cambridgeshire, United Kingdom
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12
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Gaur P, Verma V, Elayyan MA, Ramlaoui Z, Barry ST, Valge-Archer VE, Smith PD, Gupta S, Khleif SN. Abstract 4217: MEKi in combination with anti-OX40 generates metabolically fit effector CD8+ T cells, enhances stem cell-like memory CD8+ T cells, and leads to strong anti-tumor activity. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-4217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
In the tumor microenvironment (TME), T cell exhaustion and short persistence of effector cells are crucial factors that limit the efficacy of endogenously generated or adoptively transferred effector cells. Regenerative stem-cell memory CD62LhiCD44lowSca1+ CD8+ CD8+ T cells (TSCM) persist longer and produce cells with more vital effector functions. OX40, a member of TNFRSF4, has been shown to promote the expansion and proliferation of activated effector T cells, leading to the generation of robust anti-tumor responses and immune memory. However, treatment with anti-OX40 as a single therapeutic modality has not generated desirable clinical outcomes. A combination of immune modulators has been found to enhance the therapeutic efficacy synergistically. Recently, we reported that inhibition of MEK1/2 using selumetinib (AZD6244) leads to a significant increase in the numbers of CD8+ TSCM cells with self-renewability, enhanced multipotency and proliferative capacity, leading to potent anti-tumor effects. Therefore, here we combined selumetinib with anti-OX40 to investigate if enhanced immune-mediated anti-tumor responses could be obtained. Using three mouse tumor models (TC1, B16, and CT26), we found that combination of MEKi with anti-OX40 enhances the anti-tumor activity by increasing the expansion of total and antigen-specific CD8+ T cells in the TME. These CD8+ T cells have higher functional activity as seen by increased Granzyme B and INF-γ production. We also found similar results after adoptive cell therapy (ACT) where infusion of MEKi-treated cells in B16 tumor-bearing mice synergized with anti-OX40 agonist treatment. Interestingly, anti-OX40 treatment of MEKi-treated CD8+ T cells enhanced the metabolic fitness as demonstrated by low mitochondrial potential and enhanced Oxygen Consumption Rates (OCR), Spare Respiratory Capacity (SRC), and Extra-cellular Acidification Rates (ECAR) compared to anti-OX40 treatment alone. Furthermore, OX40 agonist significantly enhanced the longevity of MEKi-induced CD8+ TSCM cells. In summary, our data provide a novel strategy to utilize MEKi to enhance the efficacy of ACT and combination immunotherapy using anti-OX40 agonist.
Citation Format: Pankaj Gaur, Vivek Verma, Mays Alreem Elayyan, Zainab Ramlaoui, Simon T. Barry, Viia E. Valge-Archer, Paul D. Smith, Seema Gupta, Samir N. Khleif. MEKi in combination with anti-OX40 generates metabolically fit effector CD8+ T cells, enhances stem cell-like memory CD8+ T cells, and leads to strong anti-tumor activity [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 4217.
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Affiliation(s)
- Pankaj Gaur
- 1Georgetown University Medical Center, Washington, DC
| | - Vivek Verma
- 1Georgetown University Medical Center, Washington, DC
| | | | | | | | | | | | - Seema Gupta
- 1Georgetown University Medical Center, Washington, DC
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13
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Grazini U, O'Neill DJ, Martin M, Xu C, Floch N, Smith PD, Cuomo E. Abstract 5353: PIK3CA and PTEN mutations as drivers of osimertinib resistance in patients with NSCLC. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-5353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Osimertinib is a third-generation EGFR-TKI approved for the first-line treatment of EGFR-driven lung adenocarcinomas. High response rates to osimertinib are observed in patients with activating EGFR mutations. However, there is variability in duration of response and patients eventually develop acquired resistance.Preclinical validation of potential acquired resistance mutations identified in relapsed patients treated with osimertinib is a key challenge to develop new strategies to improve outcomes for patients with EGFR mutation positive NSCLC. Tissue and ctDNA NGS analysis from relapsed patients treated first-line with osimertinib in the FLAURA and ORCHARD trials identified PIK3CA gain of function (GOF 11%) and PTEN loss of function (LOF 5%) mutations.To test whether PIK3CA activating mutations can drive resistance to osimertinib we introduced PIK3CA activating variants (PIK3CA-H1047R and PIK3CA-E453K) or knocked-out PTEN in NSCLC lung cancer cell lines harbouring EGFR activating mutations and WT PIK3CA/PTEN using CRISPR/Cas9 technology. Our results show that PIK3CA GOF and PTEN LOF mutations conferred resistance to osimertinib in vitro. Resistance was associated with increased EC50 for osimertinib and diminished apoptotic response in NSCLC PIK3CA GOF and PTEN LOF mutant CRISPR cell lines when compared to parental cells. Protein analysis by western blot also showed an increase in the basal and osimertinib treated levels of pAKT and pS6 in PIK3CA/PTEN CRISPR engineered cell lines, indicating activation of downstream PI3K/AKT and MAPK signalling pathways in the osimertinib-resistant cells. Importantly, our in vitro experiments from multiple cell line models indicated that PIK3CA-mediated resistance to osimertinib could be partially reversed by co-treatment with AKT (capivasertib, AstraZeneca) and PI3K alpha (alpelisib, Novartis) inhibitors; PTEN-mediated resistance could be rescued by co-treatment with capivasertib and PI3K beta (AZD8186, AstraZeneca) inhibitors. We next examined the in vivo efficacy of osimertinib + AKT/PI3K inhibitors therapies in NSCLC xenograft models. Our in vivo analysis show that PIK3CA GOF CRISPR engineered cells displayed diminished response to osimertinib when implanted in mice; importantly, combination with AKT (capivasertib) or PI3K alpha (alpelisib) inhibitors enhanced response on treatment and delayed outgrowth after withdrawal treatment. In addition, we observed that combination treatment with capivasertib induced tumour stasis in a PIK3CA-E454K and two PTENloss PDX models.Altogether our in vitro and in vivo data provide evidence of PIK3CA mutants and PTEN loss-driven mechanisms of resistance to osimertinib and offer possible therapeutic combination strategies for those patients that develop resistance or experience a sub-optimal response to osimertinib through PIK3CA/PTEN mutations
Citation Format: Ursula Grazini, Daniel J. O'Neill, Matthew Martin, Chintia Xu, Nicolas Floch, Paul D. Smith, Emanuela Cuomo. PIK3CA and PTEN mutations as drivers of osimertinib resistance in patients with NSCLC [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5353.
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14
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Soni SE, Le NK, Buller M, Modica AD, Kumar A, Smith PD, Laronga C. Complication Profile of Total Submuscular Versus Prepectoral Tissue Expander Placement: A Retrospective Cohort Study. Ann Plast Surg 2022; 88:S439-S442. [PMID: 35502960 DOI: 10.1097/sap.0000000000003165] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We sought to compare the safety profile of prepectoral breast reconstruction with total submuscular tissue expander reconstruction, previously our standard. Primary outcomes of interest in this retrospective cohort study were incidence of infection, hematoma, seroma, mastectomy flap necrosis, and reconstruction loss. METHODS Total submuscular and prepectoral with acellular dermal matrix reconstructions consecutively performed by a single surgeon (P.D.S.) between January 1, 2016, and December 31, 2019, were compared. Demographic and clinical characteristics, as well as complications and complication types, were extracted for all patients. A t test was used to assess differences in continuous variables. Multivariate logistics regression was used to assess the association between type of reconstruction and complication rate. The statistical significance was set at 0.05 for all comparisons. RESULTS A total of 133 patients (234 breasts) were included. There was a significantly greater incidence of infection (16.5% vs 5.5%, P < 0.01) in the prepectoral/acellular dermal matrix cohort. However, reconstructive loss was low in both cohorts (2.5% and 3.0%, P = 0.83). Adjusted odds ratio for complications in the prepectoral cohort was 2.26, but this was not statistically significant (adjusted P = 0.24). CONCLUSIONS Prepectoral breast reconstruction shares an overall complication profile that is not greater than that of total submuscular reconstruction. It is associated with a greater risk of infection; however, the ability to salvage the reconstruction with early, aggressive intervention results in low rates of reconstructive loss, comparable with those of total submuscular reconstruction.
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Affiliation(s)
- Sara E Soni
- From the Department of Plastic Surgery, University of South Florida Morsani College of Medicine
| | - Nicole K Le
- From the Department of Plastic Surgery, University of South Florida Morsani College of Medicine
| | - Mitchell Buller
- From the Department of Plastic Surgery, University of South Florida Morsani College of Medicine
| | - Ashley D Modica
- From the Department of Plastic Surgery, University of South Florida Morsani College of Medicine
| | - Ambuj Kumar
- Department of Health Outcomes and Behavior, University of South Florida Morsani College of Medicine
| | | | - Christine Laronga
- Department of Women's Oncology, Breast Program, H. Lee Moffitt Cancer Center, Tampa, FL
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15
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Gogleva A, Polychronopoulos D, Pfeifer M, Poroshin V, Ughetto M, Martin MJ, Thorpe H, Bornot A, Smith PD, Sidders B, Dry JR, Ahdesmäki M, McDermott U, Papa E, Bulusu KC. Knowledge graph-based recommendation framework identifies drivers of resistance in EGFR mutant non-small cell lung cancer. Nat Commun 2022; 13:1667. [PMID: 35351890 PMCID: PMC8964738 DOI: 10.1038/s41467-022-29292-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 03/09/2022] [Indexed: 12/25/2022] Open
Abstract
Resistance to EGFR inhibitors (EGFRi) presents a major obstacle in treating non-small cell lung cancer (NSCLC). One of the most exciting new ways to find potential resistance markers involves running functional genetic screens, such as CRISPR, followed by manual triage of significantly enriched genes. This triage process to identify ‘high value’ hits resulting from the CRISPR screen involves manual curation that requires specialized knowledge and can take even experts several months to comprehensively complete. To find key drivers of resistance faster we build a recommendation system on top of a heterogeneous biomedical knowledge graph integrating pre-clinical, clinical, and literature evidence. The recommender system ranks genes based on trade-offs between diverse types of evidence linking them to potential mechanisms of EGFRi resistance. This unbiased approach identifies 57 resistance markers from >3,000 genes, reducing hit identification time from months to minutes. In addition to reproducing known resistance markers, our method identifies previously unexplored resistance mechanisms that we prospectively validate. Resistance to EGFR inhibitors presents a major obstacle in treating non-small cell lung cancer. Here, the authors develop a recommender system ranking genes based on trade-offs between diverse types of evidence linking them to potential mechanisms of EGFRi resistance.
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16
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Tu E, McGlinchey K, Wang J, Martin P, Ching SL, Floc’h N, Kurasawa J, Starrett JH, Lazdun Y, Wetzel L, Nuttall B, Ng FS, Coffman KT, Smith PD, Politi K, Cooper ZA, Streicher K. Anti-PD-L1 and anti-CD73 combination therapy promotes T cell response to EGFR-mutated NSCLC. JCI Insight 2022; 7:e142843. [PMID: 35132961 PMCID: PMC8855814 DOI: 10.1172/jci.insight.142843] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/15/2021] [Indexed: 12/14/2022] Open
Abstract
Treatment with anti-PD-1 and anti-PD-L1 therapies has shown durable clinical benefit in non-small cell lung cancer (NSCLC). However, patients with NSCLC with epidermal growth factor receptor (EGFR) mutations do not respond as well to treatment as patients without an EGFR mutation. We show that EGFR-mutated NSCLC expressed higher levels of CD73 compared with EGFR WT tumors and that CD73 expression was regulated by EGFR signaling. EGFR-mutated cell lines were significantly more resistant to T cell killing compared with WT cell lines through suppression of T cell proliferation and function. In a xenograft mouse model of EGFR-mutated NSCLC, neither anti-PD-L1 nor anti-CD73 antibody alone inhibited tumor growth compared with the isotype control. In contrast, the combination of both antibodies significantly inhibited tumor growth, increased the number of tumor-infiltrating CD8+ T cells, and enhanced IFN-γ and TNF-α production of these T cells. Consistently, there were increases in gene expression that corresponded to inflammation and T cell function in tumors treated with the combination of anti-PD-L1 and anti-CD73. Together, these results further support the combination of anti-CD73 and anti-PD-L1 therapies in treating EGFR-mutated NSCLC, while suggesting that increased T cell activity may play a role in response to therapy.
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Affiliation(s)
| | - Kelly McGlinchey
- Research Early Oncology, AstraZeneca, Gaithersburg, Maryland, USA
| | | | | | | | - Nicolas Floc’h
- Oncology R&D, Bioscience, AstraZeneca, Cambridge, United Kingdom
| | - James Kurasawa
- Biologics Engineering, AstraZeneca, Gaithersburg, Maryland, USA
| | | | | | - Leslie Wetzel
- Research Early Oncology, AstraZeneca, Gaithersburg, Maryland, USA
| | | | | | | | - Paul D. Smith
- Oncology R&D, Bioscience, AstraZeneca, Cambridge, United Kingdom
| | - Katerina Politi
- Department of Pathology and Medicine, Yale School of Medicine and Yale Cancer Center, New Haven, Connecticut, USA
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17
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Shiyanbola OO, Maurer MA, Virrueta N, Walbrandt Pigarelli DL, Huang YM, Unni EJ, Smith PD. Feasibility of a Randomized Controlled Mixed Methods Trial to Address Health Literacy, Beliefs, Medication Adherence, and Self-Efficacy (ADHERE) in a Clinical Pharmacist-Led Clinic. Patient Prefer Adherence 2022; 16:679-696. [PMID: 35300357 PMCID: PMC8922467 DOI: 10.2147/ppa.s349258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/12/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To assess the feasibility and acceptability of a health literacy-psychosocial support intervention - ADHERE and explore changes in glycemic values and medication adherence. PATIENTS AND METHODS Thirty-one participants with hemoglobin A1c (HbA1c) ≥ 8% were randomly allocated to control (usual care) or intervention groups (receiving usual care plus a 6-session pharmacist-led intervention focusing on the modifiable psychosocial factors that may influence medication adherence). Feasibility metrics evaluated recruitment, retention, and intervention adherence. Questionnaires were administered to collect psychosocial factors and self-reported medication adherence at baseline, the end of the intervention, 3 months, and 6 months post intervention. HbA1c values were extracted from electronic medical records. Repeated measures analysis of variance was used to compare differences in mean outcomes between the control and intervention groups. To assess intervention acceptability, eleven individuals participated in semi-structured interviews about their intervention experiences. Qualitative content analysis was used for analyzing the interviews. RESULTS Thirty participants completed the study. Overall, the findings support the feasibility of the intervention. There were significant differences in HbA1c values. Participants in the intervention group had lower A1C (8.3 ± 1.4) than in the control group (9.2 ± 1.3) at the time of 6-month follow-up (p = 0.003). In addition, the participants in the intervention group showed improved HbA1c at 6-month follow-up (8.3 ± 1.4), compared to baseline (9.4 ± 1.5, p = 0.011) and after 6-session intervention (8.9 ± 1.6, p = 0.046). However, there were no significant differences in medication adherence between groups over time. Qualitative themes suggest participants liked the intervention and perceived the additional support from the pharmacist as beneficial. CONCLUSION A pharmacist-led intervention to provide additional health literacy-psychosocial support may contribute to long-term improvements in HbA1c. Equipping pharmacists with patient-specific diabetes medication adherence information and building in additional follow-up support for patients may improve patient health outcomes.
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Affiliation(s)
- Olayinka O Shiyanbola
- Division of Social and Administrative Sciences, School of Pharmacy, University of Wisconsin- Madison, Madison, WI, USA
- Correspondence: Olayinka O Shiyanbola, Division of Social and Administrative Sciences, School of Pharmacy, University of Wisconsin-Madison, 777 Highland Avenue, Madison, WI, 53705, USA, Tel +1 608 890 2091, Email
| | - Martha A Maurer
- Sonderegger Research Center, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - Natasha Virrueta
- Division of Social and Administrative Sciences, School of Pharmacy, University of Wisconsin- Madison, Madison, WI, USA
| | | | - Yen-Ming Huang
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Elizabeth J Unni
- Department of Social, Behavioral, and Administrative Sciences, Touro College of Pharmacy, New York, NY, USA
| | - Paul D Smith
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
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18
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Finlay MRV, Barton P, Bickerton S, Bista M, Colclough N, Cross DAE, Evans L, Floc'h N, Gregson C, Guérot CM, Hargreaves D, Kang X, Lenz EM, Li X, Liu Y, Lorthioir O, Martin MJ, McKerrecher D, McWhirter C, O'Neill D, Orme JP, Mosallanejad A, Rahi A, Smith PD, Talbot V, Ward RA, Wrigley G, Wylot M, Xue L, Yao T, Ye Y, Zhao X. Potent and Selective Inhibitors of the Epidermal Growth Factor Receptor to Overcome C797S-Mediated Resistance. J Med Chem 2021; 64:13704-13718. [PMID: 34491761 DOI: 10.1021/acs.jmedchem.1c01055] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The epidermal growth factor receptor (EGFR) harboring activating mutations is a clinically validated target in non-small-cell lung cancer, and a number of inhibitors of the EGFR tyrosine kinase domain, including osimertinib, have been approved for clinical use. Resistance to these therapies has emerged due to a variety of molecular events including the C797S mutation which renders third-generation C797-targeting covalent EGFR inhibitors considerably less potent against the target due to the loss of the key covalent-bond-forming residue. We describe the medicinal chemistry optimization of a biochemically potent but modestly cell-active, reversible EGFR inhibitor starting point with sub-optimal physicochemical properties. These studies culminated in the identification of compound 12 that showed improved cell potency, oral exposure, and in vivo activity in clinically relevant EGFR-mutant-driven disease models, including an Exon19 deletion/T790M/C797S triple-mutant mouse xenograft model.
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Affiliation(s)
- M Raymond V Finlay
- AstraZeneca, Oncology R&D, Research & Early Development, Darwin Building, 310, Cambridge Science Park, Milton Road, Cambridge CB4 0WG, U.K
| | - Peter Barton
- AstraZeneca, Oncology R&D, Research & Early Development, Darwin Building, 310, Cambridge Science Park, Milton Road, Cambridge CB4 0WG, U.K
| | - Sue Bickerton
- AstraZeneca, Oncology R&D, Research & Early Development, Darwin Building, 310, Cambridge Science Park, Milton Road, Cambridge CB4 0WG, U.K
| | - Michal Bista
- AstraZeneca, Discovery Sciences, Research & Early Development, Darwin Building, 310, Cambridge Science Park, Milton Road, Cambridge CB4 0WG, U.K
| | - Nicola Colclough
- AstraZeneca, Oncology R&D, Research & Early Development, Darwin Building, 310, Cambridge Science Park, Milton Road, Cambridge CB4 0WG, U.K
| | - Darren A E Cross
- AstraZeneca, Oncology R&D, Research & Early Development, Darwin Building, 310, Cambridge Science Park, Milton Road, Cambridge CB4 0WG, U.K
| | - Laura Evans
- AstraZeneca, Oncology R&D, Research & Early Development, Darwin Building, 310, Cambridge Science Park, Milton Road, Cambridge CB4 0WG, U.K
| | - Nicolas Floc'h
- AstraZeneca, Oncology R&D, Research & Early Development, Darwin Building, 310, Cambridge Science Park, Milton Road, Cambridge CB4 0WG, U.K
| | - Clare Gregson
- AstraZeneca, Oncology R&D, Research & Early Development, Darwin Building, 310, Cambridge Science Park, Milton Road, Cambridge CB4 0WG, U.K
| | - Carine M Guérot
- AstraZeneca, Oncology R&D, Research & Early Development, Darwin Building, 310, Cambridge Science Park, Milton Road, Cambridge CB4 0WG, U.K
| | - David Hargreaves
- AstraZeneca, Discovery Sciences, Research & Early Development, Darwin Building, 310, Cambridge Science Park, Milton Road, Cambridge CB4 0WG, U.K
| | - Xiaoming Kang
- Pharmaron Beijing Co., Ltd., 6 Taihe Road, BDA, Beijing 100176, P. R. China
| | - Eva M Lenz
- AstraZeneca, Oncology R&D, Research & Early Development, Darwin Building, 310, Cambridge Science Park, Milton Road, Cambridge CB4 0WG, U.K
| | - Xu Li
- Pharmaron Beijing Co., Ltd., 6 Taihe Road, BDA, Beijing 100176, P. R. China
| | - Yi Liu
- Pharmaron Beijing Co., Ltd., 6 Taihe Road, BDA, Beijing 100176, P. R. China
| | - Olivier Lorthioir
- AstraZeneca, Oncology R&D, Research & Early Development, Darwin Building, 310, Cambridge Science Park, Milton Road, Cambridge CB4 0WG, U.K
| | - Matthew J Martin
- AstraZeneca, Oncology R&D, Research & Early Development, Darwin Building, 310, Cambridge Science Park, Milton Road, Cambridge CB4 0WG, U.K
| | - Darren McKerrecher
- AstraZeneca, Oncology R&D, Research & Early Development, Darwin Building, 310, Cambridge Science Park, Milton Road, Cambridge CB4 0WG, U.K
| | - Claire McWhirter
- AstraZeneca, Discovery Sciences, Research & Early Development, Darwin Building, 310, Cambridge Science Park, Milton Road, Cambridge CB4 0WG, U.K
| | - Daniel O'Neill
- AstraZeneca, Discovery Sciences, Research & Early Development, Darwin Building, 310, Cambridge Science Park, Milton Road, Cambridge CB4 0WG, U.K
| | - Jonathan P Orme
- AstraZeneca, Discovery Sciences, Research & Early Development, Darwin Building, 310, Cambridge Science Park, Milton Road, Cambridge CB4 0WG, U.K
| | - Arash Mosallanejad
- AstraZeneca, Oncology R&D, Research & Early Development, Darwin Building, 310, Cambridge Science Park, Milton Road, Cambridge CB4 0WG, U.K
| | - Amar Rahi
- AstraZeneca, Oncology R&D, Research & Early Development, Darwin Building, 310, Cambridge Science Park, Milton Road, Cambridge CB4 0WG, U.K
| | - Paul D Smith
- AstraZeneca, Oncology R&D, Research & Early Development, Darwin Building, 310, Cambridge Science Park, Milton Road, Cambridge CB4 0WG, U.K
| | - Verity Talbot
- AstraZeneca, Discovery Sciences, Research & Early Development, Darwin Building, 310, Cambridge Science Park, Milton Road, Cambridge CB4 0WG, U.K
| | - Richard A Ward
- AstraZeneca, Oncology R&D, Research & Early Development, Darwin Building, 310, Cambridge Science Park, Milton Road, Cambridge CB4 0WG, U.K
| | - Gail Wrigley
- AstraZeneca, Oncology R&D, Research & Early Development, Darwin Building, 310, Cambridge Science Park, Milton Road, Cambridge CB4 0WG, U.K
| | - Marta Wylot
- AstraZeneca, Oncology R&D, Research & Early Development, Darwin Building, 310, Cambridge Science Park, Milton Road, Cambridge CB4 0WG, U.K
| | - Lin Xue
- Pharmaron Beijing Co., Ltd., 6 Taihe Road, BDA, Beijing 100176, P. R. China
| | - Tieguang Yao
- Pharmaron Beijing Co., Ltd., 6 Taihe Road, BDA, Beijing 100176, P. R. China
| | - Yang Ye
- Pharmaron Beijing Co., Ltd., 6 Taihe Road, BDA, Beijing 100176, P. R. China
| | - Xiliang Zhao
- Pharmaron Beijing Co., Ltd., 6 Taihe Road, BDA, Beijing 100176, P. R. China
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19
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McCoull W, Boyd S, Brown MR, Coen M, Collingwood O, Davies NL, Doherty A, Fairley G, Goldberg K, Hardaker E, He G, Hennessy EJ, Hopcroft P, Hodgson G, Jackson A, Jiang X, Karmokar A, Lainé AL, Lindsay N, Mao Y, Markandu R, McMurray L, McLean N, Mooney L, Musgrove H, Nissink JWM, Pflug A, Reddy VP, Rawlins PB, Rivers E, Schimpl M, Smith GF, Tentarelli S, Travers J, Troup RI, Walton J, Wang C, Wilkinson S, Williamson B, Winter-Holt J, Yang D, Zheng Y, Zhu Q, Smith PD. Optimization of an Imidazo[1,2- a]pyridine Series to Afford Highly Selective Type I1/2 Dual Mer/Axl Kinase Inhibitors with In Vivo Efficacy. J Med Chem 2021; 64:13524-13539. [PMID: 34478292 DOI: 10.1021/acs.jmedchem.1c00920] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Inhibition of Mer and Axl kinases has been implicated as a potential way to improve the efficacy of current immuno-oncology therapeutics by restoring the innate immune response in the tumor microenvironment. Highly selective dual Mer/Axl kinase inhibitors are required to validate this hypothesis. Starting from hits from a DNA-encoded library screen, we optimized an imidazo[1,2-a]pyridine series using structure-based compound design to improve potency and reduce lipophilicity, resulting in a highly selective in vivo probe compound 32. We demonstrated dose-dependent in vivo efficacy and target engagement in Mer- and Axl-dependent efficacy models using two structurally differentiated and selective dual Mer/Axl inhibitors. Additionally, in vivo efficacy was observed in a preclinical MC38 immuno-oncology model in combination with anti-PD1 antibodies and ionizing radiation.
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Affiliation(s)
| | - Scott Boyd
- Oncology R&D, AstraZeneca, Cambridge CB4 0WG, U.K
| | - Martin R Brown
- Discovery Sciences, R&D, AstraZeneca, Cambridge CB4 0WG, U.K
| | - Muireann Coen
- Clinical Pharmacology & Safety Sciences, BioPharmaceuticals R&D, AstraZeneca, Cambridge CB4 0WG, U.K
| | | | | | - Ann Doherty
- Clinical Pharmacology & Safety Sciences, BioPharmaceuticals R&D, AstraZeneca, Cambridge CB4 0WG, U.K
| | - Gary Fairley
- Oncology R&D, AstraZeneca, Cambridge CB4 0WG, U.K
| | | | | | - Guang He
- Pharmaron Beijing Co., Ltd., 6 Taihe Road BDA, Beijing 100176, P. R. China
| | - Edward J Hennessy
- Oncology R&D, AstraZeneca, Gatehouse Park, Waltham, Massachusetts 02451, United States
| | - Philip Hopcroft
- Discovery Sciences, R&D, AstraZeneca, Cambridge CB4 0WG, U.K
| | - George Hodgson
- Discovery Sciences, R&D, AstraZeneca, Cambridge CB4 0WG, U.K
| | - Anne Jackson
- Discovery Sciences, R&D, AstraZeneca, Cambridge CB4 0WG, U.K
| | - Xiefeng Jiang
- Pharmaron Beijing Co., Ltd., 6 Taihe Road BDA, Beijing 100176, P. R. China
| | - Ankur Karmokar
- Oncology R&D, AstraZeneca, Mereside, Alderley Park, Macclesfield SK10 4TG, U.K
| | - Anne-Laure Lainé
- Pharmaceutical Sciences, BioPharmaceuticals R&D, AstraZeneca, Cambridge CB4 0WG, U.K
| | | | - Yumeng Mao
- Oncology R&D, AstraZeneca, Cambridge CB4 0WG, U.K
| | | | | | | | - Lorraine Mooney
- Oncology R&D, AstraZeneca, Mereside, Alderley Park, Macclesfield SK10 4TG, U.K
| | - Helen Musgrove
- Oncology R&D, AstraZeneca, Mereside, Alderley Park, Macclesfield SK10 4TG, U.K
| | | | - Alexander Pflug
- Discovery Sciences, R&D, AstraZeneca, Cambridge CB4 0WG, U.K
| | - Venkatesh Pilla Reddy
- Clinical Pharmacology & Safety Sciences, BioPharmaceuticals R&D, AstraZeneca, Cambridge CB4 0WG, U.K
| | | | - Emma Rivers
- Discovery Sciences, R&D, AstraZeneca, Cambridge CB4 0WG, U.K
| | | | - Graham F Smith
- Clinical Pharmacology & Safety Sciences, BioPharmaceuticals R&D, AstraZeneca, Cambridge CB4 0WG, U.K
| | - Sharon Tentarelli
- Oncology R&D, AstraZeneca, Gatehouse Park, Waltham, Massachusetts 02451, United States
| | - Jon Travers
- Oncology R&D, AstraZeneca, Cambridge CB4 0WG, U.K
| | | | | | - Cheng Wang
- Pharmaron Beijing Co., Ltd., 6 Taihe Road BDA, Beijing 100176, P. R. China
| | | | | | | | - Dejian Yang
- Pharmaron Beijing Co., Ltd., 6 Taihe Road BDA, Beijing 100176, P. R. China
| | - Yuting Zheng
- Pharmaron Beijing Co., Ltd., 6 Taihe Road BDA, Beijing 100176, P. R. China
| | - Qianxiu Zhu
- Pharmaron Beijing Co., Ltd., 6 Taihe Road BDA, Beijing 100176, P. R. China
| | - Paul D Smith
- Oncology R&D, AstraZeneca, Cambridge CB4 0WG, U.K
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20
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Eser PÖ, Paranal RM, Son J, Ivanova E, Kuang Y, Haikala HM, To C, Okoro JJ, Dholakia KH, Choi J, Eum Y, Ogino A, Missios P, Ercan D, Xu M, Poitras MJ, Wang S, Ngo K, Dills M, Yanagita M, Lopez T, Lin M, Tsai J, Floch N, Chambers ES, Heng J, Anjum R, Santucci AD, Michael K, Schuller AG, Cross D, Smith PD, Oxnard GR, Barbie DA, Sholl LM, Bahcall M, Palakurthi S, Gokhale PC, Paweletz CP, Daley GQ, Jänne PA. Oncogenic switch and single-agent MET inhibitor sensitivity in a subset of EGFR-mutant lung cancer. Sci Transl Med 2021; 13:eabb3738. [PMID: 34516823 PMCID: PMC8627689 DOI: 10.1126/scitranslmed.abb3738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Pınar Özden Eser
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA.,Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02215, USA.,Harvard Medical School, Boston, MA 02115, USA
| | - Raymond M Paranal
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Jieun Son
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA.,Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02215, USA
| | - Elena Ivanova
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Yanan Kuang
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Heidi M Haikala
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA.,Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02215, USA
| | - Ciric To
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA.,Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02215, USA
| | - Jeffrey J Okoro
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Kshiti H Dholakia
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Jihyun Choi
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Yoonji Eum
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Atsuko Ogino
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA.,Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02215, USA
| | - Pavlos Missios
- Stem Cell Program, Boston Children's Hospital, Boston, MA 02115, USA
| | - Dalia Ercan
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Man Xu
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Michael J Poitras
- Experimental Therapeutics Core, Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Stephen Wang
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Kenneth Ngo
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Michael Dills
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Masahiko Yanagita
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA.,Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Timothy Lopez
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Mika Lin
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Jeanelle Tsai
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Nicolas Floch
- Oncology R&D, Bioscience, AstraZeneca, CRUK Cambridge Institute, Robinson Way, Cambridge CB2 0RE, UK
| | - Emily S Chambers
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Jennifer Heng
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Rana Anjum
- Bioscience, Oncology R&D, AstraZeneca, 25 Gatehouse Park, Waltham, MA 02451, USA
| | - Alison D Santucci
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Kesi Michael
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Alwin G Schuller
- Bioscience, Oncology R&D, AstraZeneca, 25 Gatehouse Park, Waltham, MA 02451, USA
| | - Darren Cross
- Global Medical Affairs, Oncology Business Unit, AstraZeneca, 136 Hills Road, Cambridge CB2 8PA, UK
| | - Paul D Smith
- Oncology R&D, Bioscience, AstraZeneca, CRUK Cambridge Institute, Robinson Way, Cambridge CB2 0RE, UK
| | - Geoffrey R Oxnard
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA.,Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02215, USA
| | - David A Barbie
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA.,Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02215, USA.,Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Lynette M Sholl
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02215, USA
| | - Magda Bahcall
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA.,Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02215, USA
| | - Sangeetha Palakurthi
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Prafulla C Gokhale
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, MA 02215, USA.,Experimental Therapeutics Core, Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Cloud P Paweletz
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - George Q Daley
- Harvard Medical School, Boston, MA 02115, USA.,Stem Cell Program, Boston Children's Hospital, Boston, MA 02115, USA.,Harvard Stem Cell Institute, Cambridge, MA 02138, USA
| | - Pasi A Jänne
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA.,Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02215, USA.,Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, MA 02215, USA
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21
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Le NK, Soni SE, Smith PD, Kumar A, Dayicioglu D. Preservation of the Implant in Nipple-Sparing Mastectomies: A Retrospective Cohort Study. Ann Plast Surg 2021; 86:S491-S494. [PMID: 33538504 DOI: 10.1097/sap.0000000000002696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Mastectomies are an integral part of breast cancer treatment for many patients.1 Of those patients, a significant number have previously undergone breast augmentation before being diagnosed with breast cancer. Therefore, we developed the novel technique of performing nipple- and implant-sparing mastectomies (NISMs) for women with prior breast augmentations. This study will assess the plausibility of using NISMs versus nipple-sparing mastectomies (NSMs) in this subgroup of patients by comparing the complication rates. METHODS Data were collected on age, tumor size, tumor grade, receptors, and the interval between mastectomy and implant exchange for both groups. Descriptive statistics were used to summarize patient characteristics. Independent samples t tests, χ2 tests, and Fisher exact tests were used to compare the NISM and NSM cohorts. Logistic regression was used to assess the association between complications and mastectomy type and was summarized as an odds ratio with a 95% confidence interval. RESULTS Fifteen patients underwent an NISM and 35 patients underwent an NSM. The overall rate of complications was less in NISM cases than in NSM cases (20% vs 27%). However, this difference was not statistically significant (odds ratio, 0.54; 95% confidence interval, 0.18-1.64; P = 0.278). CONCLUSIONS The overall complication rate was lower with NISMs compared with NSMs. Nipple- and implant-sparing mastectomy is a novel, viable, and safe option for patients with breast cancer and a history of submuscular breast augmentation.
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Affiliation(s)
| | - Sara E Soni
- From the Department of Plastic Surgery, Morsani College of Medicine, University of South Florida, Tampa, FL
| | | | - Ambuj Kumar
- Department of Health Outcomes and Behavior, University of South Florida, Morsani College of Medicine, Tampa, FL
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22
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Abstract
This paper comments on the Effects of Racism on Oral Health in the United States (US). It provides the background and sets the stage to raise questions about race: how was race defined originally, what exactly is race, and how have racial categories been enumerated? Following this path, the paper broadens the scope of view regarding data attributable to racial categories pointing to social and cultural factors that influence overall health outcomes, particularly those related to oral health. Oral health researchers, advocates, providers, administrators, program planners, and funders, among others rely on data, often compiled by racial categories. We should be aware of potential vagaries that can accompany race-based data, and its interpretation and application, regarding oral health. The paper suggests we should be mindful of other influences that affect documented differences among populations regarding their oral health status.
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Affiliation(s)
- C A Evans
- College of Dentistry, University of Illinois at Chicago, IL 60612, United States
| | - P D Smith
- College of Dentistry, University of Illinois at Chicago, IL 60612, United States
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23
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Osum SH, Coutts AW, Duerre DJ, Tschida BR, Kirstein MN, Fisher J, Bell WR, Delpuech O, Smith PD, Widemann BC, Moertel CL, Largaespada DA, Watson AL. Selumetinib normalizes Ras/MAPK signaling in clinically relevant neurofibromatosis type 1 minipig tissues in vivo. Neurooncol Adv 2021; 3:vdab020. [PMID: 33978635 PMCID: PMC8095338 DOI: 10.1093/noajnl/vdab020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The MEK1/2 inhibitor selumetinib was recently approved for neurofibromatosis type 1 (NF1)-associated plexiform neurofibromas, but outcomes could be improved and its pharmacodynamic evaluation in other relevant tissues is limited. The aim of this study was to assess selumetinib tissue pharmacokinetics (PK) and pharmacodynamics (PD) using a minipig model of NF1. METHODS WT (n = 8) and NF1 (n = 8) minipigs received a single oral dose of 7.3 mg/kg selumetinib. Peripheral blood mononuclear cells (PBMCs), cerebral cortex, optic nerve, sciatic nerve, and skin were collected for PK analysis and PD analysis of extracellular regulated kinase phosphorylation (p-ERK) inhibition and transcript biomarkers (DUSP6 & FOS). RESULTS Key selumetinib PK parameters aligned with those observed in human patients. Selumetinib concentrations were higher in CNS tissues from NF1 compared to WT animals. Inhibition of ERK phosphorylation was achieved in PBMCs (mean 60% reduction), skin (95%), and sciatic nerve (64%) from all minipigs, whereas inhibition of ERK phosphorylation in cerebral cortex was detected only in NF1 animals (71%). Basal p-ERK levels were significantly higher in NF1 minipig optic nerve compared to WT and were reduced to WT levels (60%) with selumetinib. Modulation of transcript biomarkers was observed in all tissues. CONCLUSIONS Selumetinib reduces MAPK signaling in tissues clinically relevant to NF1, effectively normalizing p-ERK to WT levels in optic nerve but resulting in abnormally low levels of p-ERK in the skin. These results suggest that selumetinib exerts activity in NF1-associated CNS tumors by normalizing Ras/MAPK signaling and may explain common MEK inhibitor-associated dermatologic toxicities.
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Affiliation(s)
- Sara H Osum
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | | | | | | | - Mark N Kirstein
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, Minnesota, USA
| | - James Fisher
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, Minnesota, USA
| | - W Robert Bell
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
- Division of Neuropathology, Department of Lab Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Oona Delpuech
- Oncology R&D, AstraZeneca, Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Paul D Smith
- Oncology R&D, AstraZeneca, Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Brigitte C Widemann
- Pediatric Oncology Branch, Rare Tumor Initiative, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | | | - David A Largaespada
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
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24
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Flemington V, Davies EJ, Robinson D, Sandin LC, Delpuech O, Zhang P, Hanson L, Farrington P, Bell S, Falenta K, Gibbons FD, Lindsay N, Smith A, Wilson J, Roberts K, Tonge M, Hopcroft P, Willis SE, Roudier MP, Rooney C, Coker EA, Jaaks P, Garnett MJ, Fawell SE, Jones CD, Ward RA, Simpson I, Cosulich SC, Pease JE, Smith PD. AZD0364 Is a Potent and Selective ERK1/2 Inhibitor That Enhances Antitumor Activity in KRAS-Mutant Tumor Models when Combined with the MEK Inhibitor, Selumetinib. Mol Cancer Ther 2020; 20:238-249. [PMID: 33273059 DOI: 10.1158/1535-7163.mct-20-0002] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 07/13/2020] [Accepted: 11/06/2020] [Indexed: 11/16/2022]
Abstract
The RAS-regulated RAF-MEK1/2-ERK1/2 (RAS/MAPK) signaling pathway is a major driver in oncogenesis and is frequently dysregulated in human cancers, primarily by mutations in BRAF or RAS genes. The clinical benefit of inhibitors of this pathway as single agents has only been realized in BRAF-mutant melanoma, with limited effect of single-agent pathway inhibitors in KRAS-mutant tumors. Combined inhibition of multiple nodes within this pathway, such as MEK1/2 and ERK1/2, may be necessary to effectively suppress pathway signaling in KRAS-mutant tumors and achieve meaningful clinical benefit. Here, we report the discovery and characterization of AZD0364, a novel, reversible, ATP-competitive ERK1/2 inhibitor with high potency and kinase selectivity. In vitro, AZD0364 treatment resulted in inhibition of proximal and distal biomarkers and reduced proliferation in sensitive BRAF-mutant and KRAS-mutant cell lines. In multiple in vivo xenograft models, AZD0364 showed dose- and time-dependent modulation of ERK1/2-dependent signaling biomarkers resulting in tumor regression in sensitive BRAF- and KRAS-mutant xenografts. We demonstrate that AZD0364 in combination with the MEK1/2 inhibitor, selumetinib (AZD6244 and ARRY142886), enhances efficacy in KRAS-mutant preclinical models that are moderately sensitive or resistant to MEK1/2 inhibition. This combination results in deeper and more durable suppression of the RAS/MAPK signaling pathway that is not achievable with single-agent treatment. The AZD0364 and selumetinib combination also results in significant tumor regressions in multiple KRAS-mutant xenograft models. The combination of ERK1/2 and MEK1/2 inhibition thereby represents a viable clinical approach to target KRAS-mutant tumors.
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Affiliation(s)
- Vikki Flemington
- Bioscience, Oncology R&D, AstraZeneca, Cambridge, England, United Kingdom.
| | - Emma J Davies
- Bioscience, Oncology R&D, AstraZeneca, Cambridge, England, United Kingdom
| | - David Robinson
- Bioscience, Oncology R&D, AstraZeneca, Cambridge, England, United Kingdom
| | - Linda C Sandin
- Bioscience, Oncology R&D, AstraZeneca, Cambridge, England, United Kingdom
| | - Oona Delpuech
- Bioscience, Oncology R&D, AstraZeneca, Cambridge, England, United Kingdom
| | - Pei Zhang
- Bioscience, Oncology R&D, AstraZeneca, Cambridge, England, United Kingdom
| | - Lyndsey Hanson
- Bioscience, Oncology R&D, AstraZeneca, Cambridge, England, United Kingdom
| | - Paul Farrington
- Bioscience, Oncology R&D, AstraZeneca, Cambridge, England, United Kingdom
| | - Sigourney Bell
- Bioscience, Oncology R&D, AstraZeneca, Cambridge, England, United Kingdom
| | - Katarzyna Falenta
- Bioscience, Oncology R&D, AstraZeneca, Cambridge, England, United Kingdom
| | - Francis D Gibbons
- DMPK, Oncology, Oncology R&D, AstraZeneca, Cambridge, England, United Kingdom and Waltham, Massachusetts
| | - Nicola Lindsay
- DMPK, Oncology, Oncology R&D, AstraZeneca, Cambridge, England, United Kingdom and Waltham, Massachusetts
| | - Aaron Smith
- DMPK, Oncology, Oncology R&D, AstraZeneca, Cambridge, England, United Kingdom and Waltham, Massachusetts
| | - Joanne Wilson
- DMPK, Oncology, Oncology R&D, AstraZeneca, Cambridge, England, United Kingdom and Waltham, Massachusetts
| | - Karen Roberts
- Discovery Science, BioPharmaceuticals R&D, AstraZeneca, Cambridge, England, United Kingdom
| | - Michael Tonge
- Discovery Science, BioPharmaceuticals R&D, AstraZeneca, Cambridge, England, United Kingdom
| | - Philip Hopcroft
- Discovery Science, BioPharmaceuticals R&D, AstraZeneca, Cambridge, England, United Kingdom
| | - Sophie E Willis
- Translational Medicine, Oncology R&D, AstraZeneca, Cambridge, England, United Kingdom
| | - Martine P Roudier
- Translational Medicine, Oncology R&D, AstraZeneca, Cambridge, England, United Kingdom
| | - Claire Rooney
- Translational Medicine, Oncology R&D, AstraZeneca, Cambridge, England, United Kingdom
| | | | - Patricia Jaaks
- Wellcome Sanger Institute, Cambridge, England, United Kingdom
| | | | | | | | - Richard A Ward
- Medicinal Chemistry, Oncology R&D, AstraZeneca, Cambridge, England, United Kingdom
| | | | | | | | - Paul D Smith
- Bioscience, Oncology R&D, AstraZeneca, Cambridge, England, United Kingdom
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25
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Zgierska AE, Robinson JM, Lennon RP, Smith PD, Nisbet K, Ales MW, Boss D, Tuan WJ, Vidaver RM, Hahn DL. Increasing system-wide implementation of opioid prescribing guidelines in primary care: findings from a non-randomized stepped-wedge quality improvement project. BMC Fam Pract 2020; 21:245. [PMID: 33248458 PMCID: PMC7700706 DOI: 10.1186/s12875-020-01320-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 11/15/2020] [Indexed: 12/05/2022]
Abstract
Background Clinician utilization of practice guidelines can reduce inappropriate opioid prescribing and harm in chronic non-cancer pain; yet, implementation of “opioid guidelines” is subpar. We hypothesized that a multi-component quality improvement (QI) augmentation of “routine” system-level implementation efforts would increase clinician adherence to the opioid guideline-driven policy recommendations. Methods Opioid policy was implemented system-wide in 26 primary care clinics. A convenience sample of 9 clinics received the QI augmentation (one-hour academic detailing; 2 online educational modules; 4–6 monthly one-hour practice facilitation sessions) in this non-randomized stepped-wedge QI project. The QI participants were volunteer clinic staff. The target patient population was adults with chronic non-cancer pain treated with long-term opioids. The outcomes included the clinic-level percentage of target patients with a current treatment agreement (primary outcome), rates of opioid-benzodiazepine co-prescribing, urine drug testing, depression and opioid misuse risk screening, and prescription drug monitoring database check; additional measures included daily morphine-equivalent dose (MED), and the percentages of all target patients and patients prescribed ≥90 mg/day MED. T-test, mixed-regression and stepped-wedge-based analyses evaluated the QI impact, with significance and effect size assessed with two-tailed p < 0.05, 95% confidence intervals and/or Cohen’s d. Results Two-hundred-fifteen QI participants, a subset of clinical staff, received at least one QI component; 1255 patients in the QI and 1632 patients in the 17 comparison clinics were prescribed long-term opioids. At baseline, more QI than comparison clinic patients were screened for depression (8.1% vs 1.1%, p = 0.019) and prescribed ≥90 mg/day MED (23.0% vs 15.5%, p = 0.038). The stepped-wedge analysis did not show statistically significant changes in outcomes in the QI clinics, when accounting for the comparison clinics’ trends. The Cohen’s d values favored the QI clinics in all outcomes except opioid-benzodiazepine co-prescribing. Subgroup analysis showed that patients prescribed ≥90 mg/day MED in the QI compared to comparison clinics improved urine drug screening rates (38.8% vs 19.1%, p = 0.02), but not other outcomes (p ≥ 0.05). Conclusions Augmenting routine policy implementation with targeted QI intervention, delivered to volunteer clinic staff, did not additionally improve clinic-level, opioid guideline-concordant care metrics. However, the observed effect sizes suggested this approach may be effective, especially in higher-risk patients, if broadly implemented. Trial registration Not applicable.
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Affiliation(s)
- Aleksandra E Zgierska
- Departments of Family and Community Medicine, Public Health Sciences, and Anesthesiology and Perioperative Medicine, Penn State College of Medicine, 500 University Drive, PA, 17033, Hershey, USA.
| | - James M Robinson
- Center for Health Systems Research and Analysis, University of Wisconsin-Madison, 1109C WARF Building, 610 Walnut Street, Madison, WI, 53726, USA
| | - Robert P Lennon
- Department of Family and Community Medicine, Penn State College of Medicine, 500 University Drive, Hershey, PA, 17033, USA
| | - Paul D Smith
- Department of Family Medicine and Community Health, Wisconsin Research and Education Network (WREN), University of Wisconsin-Madison, School of Medicine and Public Health, 1100 Delaplaine Court, Madison, WI, 53715, USA
| | - Kate Nisbet
- Interstate Postgraduate Medical Association, P.O. Box 5474, Madison, WI, 53705, USA
| | - Mary W Ales
- Interstate Postgraduate Medical Association, P.O. Box 5474, Madison, WI, 53705, USA
| | - Deanne Boss
- Department of Family Medicine and Community Health, Wisconsin Research and Education Network (WREN), University of Wisconsin-Madison, School of Medicine and Public Health, 1100 Delaplaine Court, Madison, WI, 53715, USA
| | - Wen-Jan Tuan
- Department of Family Medicine and Community Health, University of Wisconsin-Madison, School of Medicine and Public Health, 1100 Delaplaine Court, Madison, WI, 53715, USA
| | - Regina M Vidaver
- Department of Family Medicine and Community Health, Wisconsin Research and Education Network (WREN), University of Wisconsin-Madison, School of Medicine and Public Health, 1100 Delaplaine Court, Madison, WI, 53715, USA
| | - David L Hahn
- Department of Family Medicine and Community Health, Wisconsin Research and Education Network (WREN), University of Wisconsin-Madison, School of Medicine and Public Health, 1100 Delaplaine Court, Madison, WI, 53715, USA
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26
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Colclough N, Chen K, Johnström P, Strittmatter N, Yan Y, Wrigley GL, Schou M, Goodwin R, Varnäs K, Adua SJ, Zhao M, Nguyen DX, Maglennon G, Barton P, Atkinson J, Zhang L, Janefeldt A, Wilson J, Smith A, Takano A, Arakawa R, Kondrashov M, Malmquist J, Revunov E, Vazquez-Romero A, Moein MM, Windhorst AD, Karp NA, Finlay MRV, Ward RA, Yates JW, Smith PD, Farde L, Cheng Z, Cross DA. Preclinical Comparison of the Blood–brain barrier Permeability of Osimertinib with Other EGFR TKIs. Clin Cancer Res 2020; 27:189-201. [DOI: 10.1158/1078-0432.ccr-19-1871] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 06/18/2020] [Accepted: 09/29/2020] [Indexed: 11/16/2022]
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27
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Floc'h N, Lim S, Bickerton S, Ahmed A, Orme J, Urosevic J, Martin MJ, Cross DAE, Cho BC, Smith PD. Osimertinib, an Irreversible Next-Generation EGFR Tyrosine Kinase Inhibitor, Exerts Antitumor Activity in Various Preclinical NSCLC Models Harboring the Uncommon EGFR Mutations G719X or L861Q or S768I. Mol Cancer Ther 2020; 19:2298-2307. [PMID: 32943544 DOI: 10.1158/1535-7163.mct-20-0103] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/22/2020] [Accepted: 08/26/2020] [Indexed: 11/16/2022]
Abstract
Osimertinib is an oral, third-generation, irreversible epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) that selectively inhibits both EGFR-TKI-sensitizing and EGFR T790M-resistance mutations with lower activity against wild-type EGFR and has demonstrated efficacy in non-small cell lung cancer (NSCLC) CNS metastases. The sensitizing mutations, the in-frame deletions in exon 19 and the L858R point mutation in exon 21, represent between 80% and 90% of all EGFR mutations. The remaining 10% to 20% are referred to as uncommon activating mutations and are a diverse group of mutations in exons 18 to 21 within the kinase domain of the EGFR gene. Excluding those found as insertion mutations in exon 20, the uncommon mutations involving codons G719, S768, and L861 are the most prevalent.Although the efficacy of EGFR-TKIs for the common EGFR mutations is well established, much less is known about rare EGFR mutations, such as exon 20 insertions, G719X, L861Q, S768I, as most of the data consist of single case reports or small case series.Using available patient-derived xenografts (PDX) and cell lines derived from two of these PDXs that harbor the G719X mutation, we have evaluated in vitro and in vivo the preclinical activity of osimertinib. We report osimertinib inhibits signaling pathways and cellular growth in G719X-mutant cell lines in vitro and demonstrate sustained tumor growth inhibition of PDX harboring the G719X mutation alone or in combination with L861Q and S768I.Together, these data support clinical testing of osimertinib in patients with uncommon EGFR NSCLC.
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Affiliation(s)
- Nicolas Floc'h
- AstraZeneca Oncology R&D, Research and Early Development, Bioscience, Cambridge, UK.
| | - Sangbin Lim
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sue Bickerton
- AstraZeneca Oncology R&D, Research and Early Development, Bioscience, Cambridge, UK
| | - Afshan Ahmed
- AstraZeneca Oncology R&D, Research and Early Development, Discovery Science, Cambridge, UK
| | - Jonathan Orme
- AstraZeneca Oncology R&D, Research and Early Development, Discovery Science, Cambridge, UK
| | - Jelena Urosevic
- AstraZeneca Oncology R&D, Research and Early Development, Bioscience, Cambridge, UK
| | - Matthew J Martin
- AstraZeneca Oncology R&D, Research and Early Development, Bioscience, Cambridge, UK
| | - Darren A E Cross
- Global Medical Affairs, Global Medicines Development, AstraZeneca, Cambridge, UK
| | - Byoung Chul Cho
- Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Paul D Smith
- AstraZeneca Oncology R&D, Research and Early Development, Bioscience, Cambridge, UK
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28
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Choi H, Deng J, Li S, Silk T, Dong L, Brea EJ, Houghton S, Redmond D, Zhong H, Boiarsky J, Akbay EA, Smith PD, Merghoub T, Wong KK, Wolchok JD. Abstract 923: Pulsatile MEK inhibition improves anti-tumor immunity and T cell function in Kras mutant lung cancer. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
KRAS is one of the most commonly identified driver oncogenes in non-small cell lung cancer (NSCLC) and is frequently associated with disease refractory to currently available modalities of treatment. Targeted therapy to inhibit MEK signaling has shown promising tumor growth control in preclinical models, but is followed by quick rebound in tumor growth. Recently, immune checkpoint blockade has demonstrated clinical activity by dis-inhibiting T cells suppressed in the tumor microenvironment. Thus, we sought to identify the most effective therapy for the treatment of KRAS mutant NSCLC patients by targeting cancer cells and activating immune infiltrating cell populations concurrently. To achieve this, we focused on studying the impact of pulsatile MEK inhibition on the immune microenvironment utilizing Kras mutant lung cancer cell lines and Kras mutant transgenic lung cancer mouse models. We found that pulsatile MEK inhibition maintained T cell activation better than continuous treatment ex vivo and in vivo. Treatment with two different MEK inhibitors (selumetinib and trametinib) each resulted in higher CTLA-4 and PD-1 expression in T cells using pulsatile treatment, compared to continuous treatment ex vivo. In addition, the pulsatile schedule showed superior anti-tumor effects and delayed drug resistance compared to continuous administration in vivo. Further, a combination of pulsatile MEK inhibitor treatment and CTLA-4 blockade resulted in the most prolonged survival of Kras tumor-bearing mice. Similar experiments in immune-deficient mice confirmed that this prolonged survival is conferred by adaptive immunity. Our findings set the foundation for a combinatorial therapeutic strategy using pulsatile targeted therapy together with immune checkpoint blockade in patients to optimally enhance tumor apoptosis and promote long-term immune response simultaneously. We are now continuing our studies using a KRAS G12C inhibitor to define its immune modulating properties and will then rationally combine with immune based therapy.
Citation Format: Hyejin Choi, Jiehui Deng, Shuai Li, Tarik Silk, Lauren Dong, Elliott J. Brea, Sean Houghton, David Redmond, Hong Zhong, Jonathan Boiarsky, Esra A. Akbay, Paul D. Smith, Taha Merghoub, Kwok-Kin Wong, Jedd D. Wolchok. Pulsatile MEK inhibition improves anti-tumor immunity and T cell function in Kras mutant lung cancer [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 923.
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Affiliation(s)
- Hyejin Choi
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jiehui Deng
- 2New York University Langone Medical Center, New York, NY
| | - Shuai Li
- 2New York University Langone Medical Center, New York, NY
| | - Tarik Silk
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lauren Dong
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Sean Houghton
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - David Redmond
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Hong Zhong
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Esra A. Akbay
- 3University of Texas Southwestern Medical Center at Dallas, Dallas, TX
| | | | - Taha Merghoub
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kwok-Kin Wong
- 2New York University Langone Medical Center, New York, NY
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29
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Abstract
There has been huge progress in the discovery of targeted cancer therapies in recent years. However, even for the most successful and impactful cancer drugs which have been approved, both innate and acquired mechanisms of resistance are commonplace. These emerging mechanisms of resistance have been studied intensively, which has enabled drug discovery scientists to learn how it may be possible to overcome such resistance in subsequent generations of treatments. In some cases, novel drug candidates have been able to supersede previously approved agents; in other cases they have been used sequentially or in combinations with existing treatments. This review summarizes the current field in terms of the challenges and opportunities that cancer resistance presents to drug discovery scientists, with a focus on small molecule therapeutics. As part of this review, common themes and approaches have been identified which have been utilized to successfully target emerging mechanisms of resistance. This includes the increase in target potency and selectivity, alternative chemical scaffolds, change of mechanism of action (covalents, PROTACs), increases in blood-brain barrier permeability (BBBP), and the targeting of allosteric pockets. Finally, wider approaches are covered such as monoclonal antibodies (mAbs), bispecific antibodies, antibody drug conjugates (ADCs), and combination therapies.
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Affiliation(s)
- Richard A Ward
- Medicinal Chemistry, Oncology R&D, AstraZeneca, Cambridge CB4 0WG, U.K
| | - Stephen Fawell
- Oncology R&D, AstraZeneca, Waltham, Massachusetts 02451, United States
| | - Nicolas Floc'h
- Bioscience, Oncology R&D, AstraZeneca, Cambridge CB4 0WG, U.K
| | | | | | - Paul D Smith
- Bioscience, Oncology R&D, AstraZeneca, Cambridge CB4 0WG, U.K
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30
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Gee S, Nelson N, Bornot A, Carter N, Cuomo ME, Dovedi SJ, Smith PD, Gianni D, Baker DJ. Developing an Arrayed CRISPR-Cas9 Co-Culture Screen for Immuno-Oncology Target ID. SLAS Discov 2020; 25:581-590. [PMID: 32375580 DOI: 10.1177/2472555220916457] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Immunotherapies including PD-L1 blockade have shown remarkable increases in the T cell-directed antitumor response; however, efficacy is seen only in a minority of patients. Recently, pooled CRISPR-Cas9 knockout (CRISPRn) screens in tumor/immune co-culture systems have identified a number of genes that confer resistance to T cell killing in pathways including antigen presentation and cytokine signaling, providing insight into tumor mechanisms that cause resistance to immunotherapies. The development of an arrayed CRISPRn screen in a tumor/immune co-culture system would allow the identification of novel targets for immuno-oncology, characterization of hits from pooled screens, and multiple assay endpoints to be measured per gene. Here, a small-scale arrayed CRISPRn screen was successfully developed to investigate the effects on a co-culture of T cells and Cas9-expressing PC9 lung adenocarcinoma cells modified to express anti-CD3 antibody on the cell surface (PC9-OKT3 T cell system). A focused CRISPRn library was designed to target genes involved in known resistance mechanisms (including antigen presentation, cytokine signaling, and apoptosis) as well as genes involved in immune synapse interactions. The viability of PC9 cells was assessed in two-dimensional adherent co-cultures via longitudinal imaging analysis. Knockout of epidermal growth factor receptor (EGFR) and PLK1 in tumor cells cultured alone or with T cells resulted in increased tumor cell death, as expected, whereas knockout of the test gene ICAM1 showed subtle donor-specific resistance to T cell killing. Taken together, these data provide proof of concept for arrayed CRISPRn screens in tumor/immune co-culture systems and warrant further investigation of in vitro co-culture models.
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Affiliation(s)
- Sarah Gee
- Discovery Biology, Discovery Sciences, R&D, AstraZeneca, Cambridge, UK
| | - Nadine Nelson
- Oncology R&D, AstraZeneca, Cambridge, Cambridgeshire, UK
| | - Aurelie Bornot
- Quantitative Biology, Discovery Sciences, R&D, AstraZeneca, Cambridge, UK
| | - Nikki Carter
- Discovery Biology, Discovery Sciences, R&D, AstraZeneca, Cambridge, UK
| | | | - Simon J Dovedi
- Oncology R&D, AstraZeneca, Cambridge, Cambridgeshire, UK
| | - Paul D Smith
- Oncology R&D, AstraZeneca, Cambridge, Cambridgeshire, UK
| | - Davide Gianni
- Discovery Biology, Discovery Sciences, R&D, AstraZeneca, Cambridge, UK
| | - David J Baker
- Discovery Biology, Discovery Sciences, R&D, AstraZeneca, Cambridge, UK
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31
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Choi H, Deng J, Li S, Silk T, Dong L, Brea EJ, Houghton S, Redmond D, Zhong H, Boiarsky J, Akbay EA, Smith PD, Merghoub T, Wong KK, Wolchok JD. Pulsatile MEK Inhibition Improves Anti-tumor Immunity and T Cell Function in Murine Kras Mutant Lung Cancer. Cell Rep 2020; 27:806-819.e5. [PMID: 30995478 PMCID: PMC6719696 DOI: 10.1016/j.celrep.2019.03.066] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 02/01/2019] [Accepted: 03/18/2019] [Indexed: 01/01/2023] Open
Abstract
KRAS is one of the driver oncogenes in non-small-cell lung cancer (NSCLC) but remains refractory to current modalities of targeted pathway inhibition, which include inhibiting downstream kinase MEK to circumvent KRAS activation. Here, we show that pulsatile, rather than continuous, treatment with MEK inhibitors (MEKis) maintains T cell activation and enables their proliferation. Two MEKis, selumetinib and trametinib, induce T cell activation with increased CTLA-4 expression and, to a lesser extent, PD-1 expression on T cells in vivo after cyclical pulsatile MEKi treatment. In addition, the pulsatile dosing schedule alone shows superior anti-tumor effects and delays the emergence of drug resistance. Furthermore, pulsatile MEKi treatment combined with CTLA-4 blockade prolongs survival in mice bearing tumors with mutant Kras. Our results set the foundation and show the importance of a combinatorial therapeutic strategy using pulsatile targeted therapy together with immunotherapy to optimally enhance tumor delay and promote long-term anti-tumor immunity.
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Affiliation(s)
- Hyejin Choi
- Ludwig Collaborative and Swim Across America Laboratory, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Jiehui Deng
- Division of Hematology & Medical Oncology, Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center, New York, NY 10016, USA
| | - Shuai Li
- Division of Hematology & Medical Oncology, Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center, New York, NY 10016, USA
| | - Tarik Silk
- Ludwig Collaborative and Swim Across America Laboratory, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Lauren Dong
- Ludwig Collaborative and Swim Across America Laboratory, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Elliott J Brea
- Molecular Pharmacology and Chemistry Program, Sloan Kettering Institute, New York, NY 10065, USA; Weill Cornell Medicine, New York, NY 10065, USA
| | - Sean Houghton
- Ludwig Collaborative and Swim Across America Laboratory, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - David Redmond
- Ludwig Collaborative and Swim Across America Laboratory, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Hong Zhong
- Ludwig Collaborative and Swim Across America Laboratory, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Jonathan Boiarsky
- Ludwig Collaborative and Swim Across America Laboratory, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Esra A Akbay
- Department of Pathology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390, USA; Simmons Comprehensive Cancer Center, Dallas, TX 75390, USA
| | - Paul D Smith
- Bioscience, iMed Oncology, AstraZeneca, CRUK Cambridge Institute, Cambridge CB2 0RE, UK
| | - Taha Merghoub
- Ludwig Collaborative and Swim Across America Laboratory, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Parker Institute for Cancer Immunotherapy, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medicine, New York, NY 10065, USA.
| | - Kwok-Kin Wong
- Division of Hematology & Medical Oncology, Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center, New York, NY 10016, USA.
| | - Jedd D Wolchok
- Ludwig Collaborative and Swim Across America Laboratory, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Parker Institute for Cancer Immunotherapy, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medicine, New York, NY 10065, USA.
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32
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Yuan X, Tang Z, Du R, Yao Z, Cheung SH, Zhang X, Wei J, Zhao Y, Du Y, Liu Y, Hu X, Gong W, Liu Y, Gao Y, Huang Z, Cao Z, Wei M, Zhou C, Wang L, Rosen N, Smith PD, Luo L. RAF dimer inhibition enhances the antitumor activity of MEK inhibitors in K-RAS mutant tumors. Mol Oncol 2020; 14:1833-1849. [PMID: 32336014 PMCID: PMC7400788 DOI: 10.1002/1878-0261.12698] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/21/2020] [Accepted: 04/22/2020] [Indexed: 12/19/2022] Open
Abstract
The mutation of K‐RAS represents one of the most frequent genetic alterations in cancer. Targeting of downstream effectors of RAS, including of MEK and ERK, has limited clinical success in cancer patients with K‐RAS mutations. The reduced sensitivity of K‐RAS‐mutated cells to certain MEK inhibitors (MEKi) is associated with the feedback phosphorylation of MEK by C‐RAF and with the reactivation of mitogen‐activated protein kinase (MAPK) signaling. Here, we report that the RAF dimer inhibitors lifirafenib (BGB‐283) and compound C show a strong synergistic effect with MEKi, including mirdametinib (PD‐0325901) and selumetinib, in suppressing the proliferation of K‐RAS‐mutated non‐small‐cell lung cancer and colorectal cancer (CRC) cell lines. This synergistic effect was not observed with the B‐RAFV600E selective inhibitor vemurafenib. Our mechanistic analysis revealed that RAF dimer inhibition suppresses RAF‐dependent MEK reactivation and leads to the sustained inhibition of MAPK signaling in K‐RAS‐mutated cells. This synergistic effect was also observed in several K‐RAS mutant mouse xenograft models. A pharmacodynamic analysis supported a role for the synergistic phospho‐ERK blockade in enhancing the antitumor activity observed in the K‐RAS mutant models. These findings support a vertical inhibition strategy in which RAF dimer and MEKi are combined to target K‐RAS‐mutated cancers, and have led to a Phase 1b/2 combination therapy study of lifirafenib and mirdametinib in solid tumor patients with K‐RAS mutations and other MAPK pathway aberrations.
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Affiliation(s)
- Xi Yuan
- Department of Discovery Biology, BeiGene (Beijing) Co., Ltd., China
| | - Zhiyu Tang
- Department of Pharmacology, BeiGene (Beijing) Co., Ltd., China
| | - Rong Du
- Department of Discovery Biology, BeiGene (Beijing) Co., Ltd., China
| | - Zhan Yao
- Program in Molecular Pharmacology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shing-Hu Cheung
- Department of Discovery Biology, BeiGene (Beijing) Co., Ltd., China
| | - Xinwen Zhang
- Department of Discovery Biology, BeiGene (Beijing) Co., Ltd., China
| | - Jing Wei
- Department of Discovery Biology, BeiGene (Beijing) Co., Ltd., China
| | - Yuan Zhao
- Department of Discovery Biology, BeiGene (Beijing) Co., Ltd., China
| | - Yunguang Du
- Department of Biochemistry, BeiGene (Beijing) Co., Ltd., China
| | - Ye Liu
- Department of Biochemistry, BeiGene (Beijing) Co., Ltd., China
| | - Xiaoxia Hu
- Department of Pharmacology, BeiGene (Beijing) Co., Ltd., China
| | - Wenfeng Gong
- Department of Pharmacology, BeiGene (Beijing) Co., Ltd., China
| | - Yong Liu
- Department of Pharmacology, BeiGene (Beijing) Co., Ltd., China
| | - Yajuan Gao
- Department of Pharmacology, BeiGene (Beijing) Co., Ltd., China
| | - Zhiyue Huang
- Global Statistics and Data Science, BeiGene (Shanghai) Co., Ltd., China
| | - Zongfu Cao
- Department of Pharmacology, BeiGene (Beijing) Co., Ltd., China
| | - Min Wei
- Department of Biochemistry, BeiGene (Beijing) Co., Ltd., China
| | - Changyou Zhou
- Department of Chemistry, BeiGene (Beijing) Co., Ltd., China
| | - Lai Wang
- Department of Pharmacology, BeiGene (Beijing) Co., Ltd., China
| | - Neal Rosen
- Program in Molecular Pharmacology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paul D Smith
- AstraZeneca, CRUK Cambridge Institute, Robinson Way, UK
| | - Lusong Luo
- External Innovation, BeiGene, Ltd., San Mateo, CA, USA
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33
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Gee S, Nelson N, Bornot A, Carter N, Cuomo ME, Dovedi SJ, Smith PD, Gianni D, Baker DJ. Developing an Arrayed CRISPR-Cas9 Co-Culture Screen for Immuno-Oncology Target ID. SLAS Discov 2020. [PMID: 32375580 DOI: 10.1177/2472555220916457.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Immunotherapies including PD-L1 blockade have shown remarkable increases in the T cell-directed antitumor response; however, efficacy is seen only in a minority of patients. Recently, pooled CRISPR-Cas9 knockout (CRISPRn) screens in tumor/immune co-culture systems have identified a number of genes that confer resistance to T cell killing in pathways including antigen presentation and cytokine signaling, providing insight into tumor mechanisms that cause resistance to immunotherapies. The development of an arrayed CRISPRn screen in a tumor/immune co-culture system would allow the identification of novel targets for immuno-oncology, characterization of hits from pooled screens, and multiple assay endpoints to be measured per gene. Here, a small-scale arrayed CRISPRn screen was successfully developed to investigate the effects on a co-culture of T cells and Cas9-expressing PC9 lung adenocarcinoma cells modified to express anti-CD3 antibody on the cell surface (PC9-OKT3 T cell system). A focused CRISPRn library was designed to target genes involved in known resistance mechanisms (including antigen presentation, cytokine signaling, and apoptosis) as well as genes involved in immune synapse interactions. The viability of PC9 cells was assessed in two-dimensional adherent co-cultures via longitudinal imaging analysis. Knockout of epidermal growth factor receptor (EGFR) and PLK1 in tumor cells cultured alone or with T cells resulted in increased tumor cell death, as expected, whereas knockout of the test gene ICAM1 showed subtle donor-specific resistance to T cell killing. Taken together, these data provide proof of concept for arrayed CRISPRn screens in tumor/immune co-culture systems and warrant further investigation of in vitro co-culture models.
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Affiliation(s)
- Sarah Gee
- Discovery Biology, Discovery Sciences, R&D, AstraZeneca, Cambridge, UK
| | - Nadine Nelson
- Oncology R&D, AstraZeneca, Cambridge, Cambridgeshire, UK
| | - Aurelie Bornot
- Quantitative Biology, Discovery Sciences, R&D, AstraZeneca, Cambridge, UK
| | - Nikki Carter
- Discovery Biology, Discovery Sciences, R&D, AstraZeneca, Cambridge, UK
| | | | - Simon J Dovedi
- Oncology R&D, AstraZeneca, Cambridge, Cambridgeshire, UK
| | - Paul D Smith
- Oncology R&D, AstraZeneca, Cambridge, Cambridgeshire, UK
| | - Davide Gianni
- Discovery Biology, Discovery Sciences, R&D, AstraZeneca, Cambridge, UK
| | - David J Baker
- Discovery Biology, Discovery Sciences, R&D, AstraZeneca, Cambridge, UK
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Huang YM, Shiyanbola OO, Chan HY, Smith PD. Patient factors associated with diabetes medication adherence at different health literacy levels: a cross-sectional study at a family medicine clinic. Postgrad Med 2020; 132:328-336. [PMID: 32233892 DOI: 10.1080/00325481.2020.1749499] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Type 2 diabetes (T2D) incurs tremendous health costs associated with various complications due to poor diabetes control. Medication adherence, which is correlated with patients' health literacy, should be consistently practiced achieving optimal diabetes control. A deeper understanding of the specific communication and psychosocial factors related to medication-taking behaviors across different levels of health literacy among people with T2D will guide the development of effective interventions and strategies to enhance medication adherence. OBJECTIVES This cross-sectional study aimed to identify salient patient factors associated with diabetes medication adherence across different levels of health literacy. METHODS A questionnaire was administered via a face-to-face approach with 205 participants at a family medicine clinic. Study participants were all above 20 years of age with T2D, were prescribed at least one oral diabetes medication, and understood English. The questionnaire assessed participants' health literacy, self-efficacy for medication use, beliefs in medicines, patient-provider communication, perceived barriers to medication adherence, and self-reported medication adherence. Separate analysis of covariance was used to compare the mean scores of patient factors related to medication adherence across people with different health literacy levels. RESULTS The mean age of participants was 61 years old, and the majority of the participants were female (57%), White (75%), and college educated (62%). Thirty-three percent of the participants had adequate health literacy, but only 43% of them reported high adherence to their diabetes medications. Analysis of covariance showed that having stronger self-efficacy (P < 0.001), lower concern beliefs about medication (P = 0.047), and fewer perceived barriers to medication-taking (P < 0.001), are necessary for better medication adherence. CONCLUSION Findings suggest that practitioners should address concern beliefs among low-adherent patients with low health literacy, help improve self-efficacy, and address perceived barriers to medication adherence among all low-adherent patients to optimally support patients' diabetes care.
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Affiliation(s)
- Yen-Ming Huang
- College of Pharmacy and Allied Health Professions, South Dakota State University , Brookings, SD, USA.,Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University , Taipei City, Taiwan
| | - Olayinka O Shiyanbola
- Division of Social and Administrative Sciences, School of Pharmacy, University of Wisconsin-Madison , Madison, WI, USA
| | - Hsun-Yu Chan
- Department of Psychology and Special Education, Texas A&M University , Commerce, TX, USA
| | - Paul D Smith
- Department of Family Medicine and Community Health, University of Wisconsin-Madison , Madison, WI, USA
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Morales Torres C, Wu MY, Hobor S, Wainwright EN, Martin MJ, Patel H, Grey W, Grönroos E, Howell S, Carvalho J, Snijders AP, Bustin M, Bonnet D, Smith PD, Swanton C, Howell M, Scaffidi P. Selective inhibition of cancer cell self-renewal through a Quisinostat-histone H1.0 axis. Nat Commun 2020; 11:1792. [PMID: 32286289 PMCID: PMC7156485 DOI: 10.1038/s41467-020-15615-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 03/19/2020] [Indexed: 12/24/2022] Open
Abstract
Continuous cancer growth is driven by subsets of self-renewing malignant cells. Targeting of uncontrolled self-renewal through inhibition of stem cell-related signaling pathways has proven challenging. Here, we show that cancer cells can be selectively deprived of self-renewal ability by interfering with their epigenetic state. Re-expression of histone H1.0, a tumor-suppressive factor that inhibits cancer cell self-renewal in many cancer types, can be broadly induced by the clinically well-tolerated compound Quisinostat. Through H1.0, Quisinostat inhibits cancer cell self-renewal and halts tumor maintenance without affecting normal stem cell function. Quisinostat also hinders expansion of cells surviving targeted therapy, independently of the cancer types and the resistance mechanism, and inhibits disease relapse in mouse models of lung cancer. Our results identify H1.0 as a major mediator of Quisinostat's antitumor effect and suggest that sequential administration of targeted therapy and Quisinostat may be a broadly applicable strategy to induce a prolonged response in patients.
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Affiliation(s)
| | - Mary Y Wu
- High-Throughput Screening, Francis Crick Institute, London, NW1 1AT, UK
| | - Sebastijan Hobor
- Cancer Evolution and Genome Instability Laboratory, Francis Crick Institute, London, NW1 1AT, UK
| | | | | | - Harshil Patel
- Bioinformatics and Biostatistics, Francis Crick Institute, London, NW1 1AT, UK
| | - William Grey
- Haematopoietic Stem Cell Laboratory, Francis Crick Institute, London, NW1 1AT, UK
| | - Eva Grönroos
- Cancer Evolution and Genome Instability Laboratory, Francis Crick Institute, London, NW1 1AT, UK
| | - Steven Howell
- Proteomics, Francis Crick Institute, London, NW1 1AT, UK
| | - Joana Carvalho
- Experimental Histopathology, Francis Crick Institute, London, NW1 1AT, UK
| | | | - Michael Bustin
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20814, USA
| | - Dominique Bonnet
- Haematopoietic Stem Cell Laboratory, Francis Crick Institute, London, NW1 1AT, UK
| | - Paul D Smith
- Oncology R&D, AstraZeneca, Cambridge, CB2 0RE, UK
| | - Charles Swanton
- Cancer Evolution and Genome Instability Laboratory, Francis Crick Institute, London, NW1 1AT, UK
- Cancer Research UK Lung Cancer Centre of Excellence, UCL Cancer Institute, University College London, London, WC1E 6BT, UK
| | - Michael Howell
- High-Throughput Screening, Francis Crick Institute, London, NW1 1AT, UK
| | - Paola Scaffidi
- Cancer Epigenetics Laboratory, Francis Crick Institute, London, NW1 1AT, UK.
- UCL Cancer Institute, University College London, London, WC1E 6DD, UK.
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Starrett JH, Guernet AA, Cuomo ME, Poels KE, van Alderwerelt van Rosenburgh IK, Nagelberg A, Farnsworth D, Price KS, Khan H, Ashtekar KD, Gaefele M, Ayeni D, Stewart TF, Kuhlmann A, Kaech SM, Unni AM, Homer R, Lockwood WW, Michor F, Goldberg SB, Lemmon MA, Smith PD, Cross DAE, Politi K. Drug Sensitivity and Allele Specificity of First-Line Osimertinib Resistance EGFR Mutations. Cancer Res 2020; 80:2017-2030. [PMID: 32193290 DOI: 10.1158/0008-5472.can-19-3819] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 12/06/2019] [Accepted: 03/09/2020] [Indexed: 12/21/2022]
Abstract
Osimertinib, a mutant-specific third-generation EGFR tyrosine kinase inhibitor, is emerging as the preferred first-line therapy for EGFR-mutant lung cancer, yet resistance inevitably develops in patients. We modeled acquired resistance to osimertinib in transgenic mouse models of EGFRL858R -induced lung adenocarcinoma and found that it is mediated largely through secondary mutations in EGFR-either C797S or L718V/Q. Analysis of circulating free DNA data from patients revealed that L718Q/V mutations almost always occur in the context of an L858R driver mutation. Therapeutic testing in mice revealed that both erlotinib and afatinib caused regression of osimertinib-resistant C797S-containing tumors, whereas only afatinib was effective on L718Q mutant tumors. Combination first-line osimertinib plus erlotinib treatment prevented the emergence of secondary mutations in EGFR. These findings highlight how knowledge of the specific characteristics of resistance mutations is important for determining potential subsequent treatment approaches and suggest strategies to overcome or prevent osimertinib resistance in vivo. SIGNIFICANCE: This study provides insight into the biological and molecular properties of osimertinib resistance EGFR mutations and evaluates therapeutic strategies to overcome resistance. GRAPHICAL ABSTRACT: http://cancerres.aacrjournals.org/content/canres/80/10/2017/F1.large.jpg.
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Affiliation(s)
| | - Alexis A Guernet
- Discovery Biology, Discovery Sciences, R&D Biopharmaceuticals, AstraZeneca, Cambridge, United Kingdom
| | - Maria Emanuela Cuomo
- Discovery Biology, Discovery Sciences, R&D Biopharmaceuticals, AstraZeneca, Cambridge, United Kingdom
| | - Kamrine E Poels
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; and Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Iris K van Alderwerelt van Rosenburgh
- Department of Pharmacology, Yale School of Medicine, New Haven, Connecticut
- Cancer Biology Institute, Yale School of Medicine, New Haven, Connecticut
| | - Amy Nagelberg
- Department of Integrative Oncology, British Columbia Cancer and Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dylan Farnsworth
- Department of Integrative Oncology, British Columbia Cancer and Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Hina Khan
- Warren Alpert Medical School, Brown University, Providence, Rhode Island; and Lifespan Cancer Institute, Providence, Rhode Island
| | - Kumar Dilip Ashtekar
- Department of Pharmacology, Yale School of Medicine, New Haven, Connecticut
- Cancer Biology Institute, Yale School of Medicine, New Haven, Connecticut
| | | | - Deborah Ayeni
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
| | - Tyler F Stewart
- Department of Medicine (Section of Medical Oncology), Yale School of Medicine, New Haven, Connecticut
| | - Alexandra Kuhlmann
- Department of Immunobiology, Yale School of Medicine, New Haven, Connecticut
| | - Susan M Kaech
- NOMIS Center for Immunobiology and Microbial Pathogenesis, The Salk Institute, La Jolla, California
| | - Arun M Unni
- Meyer Cancer Center, Weill Cornell Medicine, New York, New York
| | - Robert Homer
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
- Pathology and Laboratory Medicine Service, VA CT HealthCare System, West Haven, Connecticut
| | - William W Lockwood
- Department of Integrative Oncology, British Columbia Cancer and Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Franziska Michor
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; and Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, Massachusetts; Center for Cancer Evolution, Dana-Farber Cancer Institute, Boston, Massachusetts; The Broad Institute of Harvard and MIT, Cambridge, Massachusetts; and The Ludwig Center at Harvard, Boston, Massachusetts
| | - Sarah B Goldberg
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut
- Department of Medicine (Section of Medical Oncology), Yale School of Medicine, New Haven, Connecticut
| | - Mark A Lemmon
- Department of Pharmacology, Yale School of Medicine, New Haven, Connecticut
- Cancer Biology Institute, Yale School of Medicine, New Haven, Connecticut
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut
| | - Paul D Smith
- R&D Oncology, AstraZeneca, Cambridge, United Kingdom
| | | | - Katerina Politi
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut.
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut
- Department of Medicine (Section of Medical Oncology), Yale School of Medicine, New Haven, Connecticut
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Kurian N, Cohen TS, Öberg L, De Zan E, Skogberg G, Vollmer S, Baturcam E, Svanberg P, Bonn B, Smith PD, Vaarala O, Cunoosamy DM. Dual Role For A MEK Inhibitor As A Modulator Of Inflammation And Host Defense Mechanisms With Potential Therapeutic Application In COPD. Int J Chron Obstruct Pulmon Dis 2019; 14:2611-2624. [PMID: 32063702 PMCID: PMC6885002 DOI: 10.2147/copd.s211619] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 09/23/2019] [Indexed: 12/28/2022] Open
Abstract
Background Unlike p38 mitogen-activated protein Kinases (MAPK) that has been extensively studied in the context of lung-associated pathologies in COPD, the role of the dual-specificity mitogen-activated protein kinase kinase (MEK1/2) or its downstream signaling molecule extracellular signal-regulated kinases 1/2 (ERK1/2) in COPD is poorly understood. Objectives The aim of this study was to address whether MEK1/2 pathway activation is linked to COPD and that targeting this pathway can improve lung inflammation through decreased immune-mediated inflammatory responses without compromising bacterial clearance. Methods Association of MEK1/2 pathway activation to COPD was investigated by immunohistochemistry using lung tissue biopsies from COPD and healthy individuals and through analysis of sputum gene expression data from COPD patients. The anti-inflammatory effect of MEK1/2 inhibition was assessed on cytokine release from lipopolysaccharide-stimulated alveolar macrophages. The effect of MEK1/2 inhibition on bacterial clearance was assessed using Staphylococcus aureus killing assays with RAW 264.7 macrophage cell line and human neutrophils. Results We report here MEK1/2 pathway activation demonstrated by increased pERK1/2 staining in bronchial epithelium and by the presence of MEK gene activation signature in sputum samples from COPD patients. Inhibition of MEK1/2 resulted in a superior anti-inflammatory effect in human alveolar macrophages in comparison to a p38 inhibitor. Furthermore, MEK1/2 inhibition led to an increase in bacterial killing in human neutrophils and RAW 264.7 cells that was not observed with the p38 inhibitor. Conclusion Our data demonstrate the activation of MEK1/2 pathway in COPD and highlight a dual function of MEK1/2 inhibition in improving host defense responses whilst also controlling inflammation.
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Affiliation(s)
- Nisha Kurian
- Respiratory Inflammation and Autoimmune (RIA) Precision Medicine Unit, Precision Medicine, Oncology R&D, AstraZeneca, Gothenburg, Sweden
| | | | - Lisa Öberg
- Translational Science and Experimental Medicine, Research and Early Development, RIA, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Erica De Zan
- Translational Science and Experimental Medicine, Research and Early Development, RIA, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Gabriel Skogberg
- Bioscience, Research and Early Development, RIA, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Stefan Vollmer
- Translational Science and Experimental Medicine, Research and Early Development, RIA, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Engin Baturcam
- Translational Science and Experimental Medicine, Research and Early Development, RIA, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Petter Svanberg
- Drug Metabolism and Pharmacokinetics, Research and Early Development, RIA, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Britta Bonn
- Drug Metabolism and Pharmacokinetics, Research and Early Development, RIA, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Paul D Smith
- Bioscience, Oncology R&D, AstraZeneca, Cambridge, UK
| | - Outi Vaarala
- Translational Science and Experimental Medicine, Research and Early Development, RIA, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Danen M Cunoosamy
- Translational Science and Experimental Medicine, Research and Early Development, RIA, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
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Sale MJ, Minihane E, Monks NR, Gilley R, Richards FM, Schifferli KP, Andersen CL, Davies EJ, Vicente MA, Ozono E, Markovets A, Dry JR, Drew L, Flemington V, Proia T, Jodrell DI, Smith PD, Cook SJ. Targeting melanoma's MCL1 bias unleashes the apoptotic potential of BRAF and ERK1/2 pathway inhibitors. Nat Commun 2019; 10:5167. [PMID: 31727888 PMCID: PMC6856071 DOI: 10.1038/s41467-019-12409-w] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 09/06/2019] [Indexed: 01/01/2023] Open
Abstract
BRAF and MEK1/2 inhibitors are effective in melanoma but resistance inevitably develops. Despite increasing the abundance of pro-apoptotic BIM and BMF, ERK1/2 pathway inhibition is predominantly cytostatic, reflecting residual pro-survival BCL2 family activity. Here, we show that uniquely low BCL-XL expression in melanoma biases the pro-survival pool towards MCL1. Consequently, BRAF or MEK1/2 inhibitors are synthetic lethal with the MCL1 inhibitor AZD5991, driving profound tumour cell death that requires BAK/BAX, BIM and BMF, and inhibiting tumour growth in vivo. Combination of ERK1/2 pathway inhibitors with BCL2/BCL-w/BCL-XL inhibitors is stronger in CRC, correlating with a low MCL1:BCL-XL ratio; indeed the MCL1:BCL-XL ratio is predictive of ERK1/2 pathway inhibitor synergy with MCL1 or BCL2/BCL-w/BCL-XL inhibitors. Finally, AZD5991 delays acquired BRAFi/MEKi resistance and enhances the efficacy of an ERK1/2 inhibitor in a model of acquired BRAFi + MEKi resistance. Thus combining ERK1/2 pathway inhibitors with MCL1 antagonists in melanoma could improve therapeutic index and patient outcomes.
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Affiliation(s)
- Matthew J Sale
- Signalling Programme, The Babraham Institute, Babraham Research Campus, Cambridge, CB22 3AT, UK.
| | - Emma Minihane
- Signalling Programme, The Babraham Institute, Babraham Research Campus, Cambridge, CB22 3AT, UK
| | - Noel R Monks
- Oncology R&D, AstraZeneca, One Medimmune Way, Gaithersburg, MD, 20878, USA
| | - Rebecca Gilley
- Signalling Programme, The Babraham Institute, Babraham Research Campus, Cambridge, CB22 3AT, UK
| | - Frances M Richards
- Pharmacology and Drug Development Group, Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, UK
| | - Kevin P Schifferli
- Oncology R&D, AstraZeneca, One Medimmune Way, Gaithersburg, MD, 20878, USA
| | | | - Emma J Davies
- Oncology R&D, AstraZeneca, Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, UK
| | - Mario Aladren Vicente
- CRUK Therapeutic Discovery Laboratories, Jonas Webb Building, Babraham Research Campus, Cambridge, CB22 3AT, UK
| | - Eiko Ozono
- Signalling Programme, The Babraham Institute, Babraham Research Campus, Cambridge, CB22 3AT, UK
| | | | - Jonathan R Dry
- Oncology R&D, AstraZeneca, 35 Gatehouse Drive, Waltham, MA, 02451, USA
| | - Lisa Drew
- Oncology R&D, AstraZeneca, 35 Gatehouse Drive, Waltham, MA, 02451, USA
| | - Vikki Flemington
- Oncology R&D, AstraZeneca, Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, UK
| | - Theresa Proia
- Oncology R&D, AstraZeneca, 35 Gatehouse Drive, Waltham, MA, 02451, USA
| | - Duncan I Jodrell
- Pharmacology and Drug Development Group, Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, UK
| | - Paul D Smith
- Oncology R&D, AstraZeneca, Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, UK
| | - Simon J Cook
- Signalling Programme, The Babraham Institute, Babraham Research Campus, Cambridge, CB22 3AT, UK.
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Erikson M, Smith PD, Sparks SW. Best Practices to Advance Health Literacy in a Wisconsin Adult Literacy Coalition. Health Lit Res Pract 2019; 3:S8-S14. [PMID: 31773084 PMCID: PMC6857770 DOI: 10.3928/24748307-20190405-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 04/05/2019] [Indexed: 11/20/2022] Open
Abstract
Background: Wisconsin Literacy Incorporated is a statewide adult and family literacy coalition representing 75 community-based literacy organizations. This coalition focuses its work in four areas: (1) building capacity of its member agencies, (2) advocating for literacy, (3) preparing adults in worker readiness and career pathways, and (4) improving how health information is communicated through its division, Wisconsin Health Literacy (WHL). Brief Description of Activity: This article outlines how an adult basic education coalition successfully developed a statewide health literacy coalition that later transformed into a division of Wisconsin Literacy through a three-phase approach that included: (1) raising awareness and educating health care and literacy providers about health literacy, (2) implementing health literacy interventions through various grant funding, and (3) disseminating and sharing findings from such health literacy interventions to a broad audience. Implementation: Beginning its awareness work in 2003 with help from a physician champion, WHL implemented best practices within each of the three areas of approach. After being implemented, the initial volunteer-based health literacy coalition was transformed into a division of Wisconsin Literacy Incorporated. Results: The division now includes a full-time director, its own website, funding for community interventions, and a business plan for fee-for-service efforts with health care providers, public health agencies, and other stakeholders. Key relationships with Wisconsin health care organizations provided WHL venues to present about health literacy throughout the state and beyond. Wisconsin Literacy Incorporated helped secure a solid infrastructure by hosting two planning retreats and implementing both strategic and business plans for the newly formed division. Offering fee-for-service health literacy training to health care providers brought in new revenue to sustain the division and obtain buy-in from health care agencies on the importance of health literate organizations. Finally, participating in key partner coalitions and Communities of Practice allowed WHL to share experiences and best practices with a national audience. Lessons Learned: The importance of intentionally raising awareness in strategic health care settings across the state fostered many partnerships. Investing in a strategic planning retreat and a business plan guided the division's success. Delivering educational workshops in community-based literacy organizations and trusted settings where adults regularly go to learn was key to successful implementation. [HLRP: Health Literacy Research and Practice. 2019;3(Suppl.):S8–S14.] Plain Language Summary: Wisconsin Literacy Incorporated is an adult basic education coalition that built a health literacy division over several years. Using best practices such as raising awareness, implementing pilot projects, and broadly sharing its experience, the Wisconsin Health Literacy division advanced the understanding and commitment to health literacy in and beyond Wisconsin.
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Affiliation(s)
- Michele Erikson
- Address correspondence to Michele Erikson, BA, Wisconsin Literacy Incorporated, 211 South Paterson Street, Suite 260, Madison, WI 53703;
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Mishuris RG, Palmisano J, McCullagh L, Hess R, Feldstein DA, Smith PD, McGinn T, Mann DM. Using normalisation process theory to understand workflow implications of decision support implementation across diverse primary care settings. BMJ Health Care Inform 2019; 26:bmjhci-2019-100088. [PMID: 31630113 PMCID: PMC7062348 DOI: 10.1136/bmjhci-2019-100088] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/26/2019] [Accepted: 09/30/2019] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Effective implementation of technologies into clinical workflow is hampered by lack of integration into daily activities. Normalisation process theory (NPT) can be used to describe the kinds of 'work' necessary to implement and embed complex new practices. We determined the suitability of NPT to assess the facilitators, barriers and 'work' of implementation of two clinical decision support (CDS) tools across diverse care settings. METHODS We conducted baseline and 6-month follow-up quantitative surveys of clinic leadership at two academic institutions' primary care clinics randomised to the intervention arm of a larger study. The survey was adapted from the NPT toolkit, analysing four implementation domains: sense-making, participation, action, monitoring. Domains were summarised among completed responses (n=60) and examined by role, institution, and time. RESULTS The median score for each NPT domain was the same across roles and institutions at baseline, and decreased at 6 months. At 6 months, clinic managers' participation domain (p=0.003), and all domains for medical directors (p<0.003) declined. At 6 months, the action domain decreased among Utah respondents (p=0.03), and all domains decreased among Wisconsin respondents (p≤0.008). CONCLUSIONS This study employed NPT to longitudinally assess the implementation barriers of new CDS. The consistency of results across participant roles suggests similarities in the work each role took on during implementation. The decline in engagement over time suggests the need for more frequent contact to maintain momentum. Using NPT to evaluate this implementation provides insight into domains which can be addressed with participants to improve success of new electronic health record technologies. TRIAL REGISTRATION NUMBER NCT02534987.
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Affiliation(s)
| | - Joseph Palmisano
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Lauren McCullagh
- Northwell Health and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Rachel Hess
- University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - David A Feldstein
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Paul D Smith
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Thomas McGinn
- Northwell Health and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Devin M Mann
- New York University School of Medicine, New York City, New York, USA
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Floch N, Bickerton S, Martin MJ, Cross DA, Smith PD. Abstract 1330: Osimertinib, an irreversible next generation EGFR tyrosine kinase inhibitor, exerts anti-tumor activity in various preclinical NSCLC models harboring G719X mutant-EGFR. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-1330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Two first-generation (erlotinib & gefitinib), two second generation (afatinib & dacomitinib) and a third generation (osimertinib) EGFR-TKIs are currently available for the management of EGFR mutation-positive NSCLC. All these TKIs are effective in patients with NSCLC whose tumors harbor the in-frame deletions in exon 19 and the L858R point mutation in exon 21. These two mutations represent 90% of all EGFR mutations. Osimertinib, when used in the front-line setting, has shown more favorable treatment outcomes than first-generation EGFR-TKIs. In approximately 50% of patients, resistance to first and second generation TKI is mediated by the acquisition of the ‘gatekeeper’ mutation T790M. Currently, osimertinib is the only registered EGFR TKI that is active against exon 19 deletions and L858R mutation, regardless of the presence of T790M mutation.
While the efficacy of EGFR TKIs for the common EGFR mutations is well established, much less is known about rare EGFR mutations such as exon 20 insertions, G719X, L861Q, S768I, as most of the data consist of single case reports or small case series. This work describes the therapeutic potential of osimertinib in tumors harboring the G719X mutation alone or in combination with L861Q and S768I.
Using available patient-derived xenografts (PDX) and cell lines derived from two of these PDX which habor the G719X mutation, we have evaluated in vitro and in vivo the pre-clinical activity of osimertinib.
We show that osimertinib inhibits signalling pathways and cellular growth of G719X cell lines in vitro. This translates into sustained tumor growth inhibition in vivo in 3 out of 4 PDX explored (87%, p<0.001, 158% p<0.001 & 181%, p<0.001 respectively at day 14) when compared to the control group. Importantly, in these in vivo models, osimertinib achieved exposure consistent with those observed in patients treated with an 80 mg clinical dose. Moreover, osimertinib demonstrates superior activity to afatinib (145%, p<0.001, & 58% p<0.01 respectively at day 14) in a model harboring the G719A. Out of the 4 PDX models explored in vivo, one model appeared to be inherently resistant to osimertinib. Further genomic characterisation revealed that the model displayed amplification of c-MET, a well know mechanism of resistance to EGFR-TKI. Subsequent in vivo pre-clinical study shows that the model is sensitive to c-MET inhibition. In addition, we performed pharmacodynamic studies to explore the relationship between efficacy and target/pathway modulation. These studies establish a clear relationship between depth and duration of inhibition of the phopshorylation of EGFR and anti-tumor efficacy.
The work presented herein demonstrates that osimertinib has the potential to improve upon the current treatment options for NSCLC patients whose tumors harbor a G719X mutation, and warrants further clinical investigation.
Citation Format: Nicolas Floch, Sue Bickerton, Matthew J. Martin, Darren A. Cross, Paul D. Smith. Osimertinib, an irreversible next generation EGFR tyrosine kinase inhibitor, exerts anti-tumor activity in various preclinical NSCLC models harboring G719X mutant-EGFR [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 1330.
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Floch N, Finlay MRV, Bianco A, Bickerton S, Colclough N, Cross DA, Cuomo EM, Guerot CM, Hargreaves D, Martin MJ, McKerrecher D, O’Neill DJ, Orme JP, Rahi A, Smith PD, Ward RA. Abstract 4451: Evaluation of the therapeutic potential of phosphine oxide pyrazole inhibitors in tumors harboring EGFR C797S mutation. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-4451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Osimertinib is a next-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) with activity against both the activating and the ‘gatekeeper’ T790M EGFR mutations. An acquired EGFR C797S mutation has been reported to mediate osimertinib resistance in approximately 15% and 7% of patients in second-line and first-line treatment respectively. This percentage in the first-line setting will likely evolve as the first line data mature. The C797S mutation leads to the loss of covalent binding of osimertinib to mutant EGFR. The high affinity of the EGFR triple mutant for ATP presents a challenge for reversible inhibitor design, particularly as the loss of the cysteine at position 797 precludes the previously exploited covalent approaches. We have explored various approaches to address this challenge, including an effort to maximise reversible affinity to target the C797S mutation without requiring a covalent bond. We describe herein the therapeutic potential of reversible phosphine oxide pyrazole inhibitors in tumors harboring C797S.
Using structure-based design, we were able to design a series of phosphine oxide pyrazole inhibitors that displayed exceptionally high biochemical potency against EGFR C797S mutation, which translated into good activity in cell-based assays. Using CRISPR-Cas 9 genome editing technology, we engineered cellular disease-relevant models to express the C797S mutation to evaluate potency in vitro and in vivo.
By modulating the physicochemical properties of our in vitro leads, we were able to achieve good oral exposure of cellularly active EGFR C797S inhibitors such as AZ’7608. We showed that AZ’7608 inhibits signalling pathways and cellular growth of C797S EGFR cell lines in vitro and demonstrated an improved WT EGFR margin. This translated into 52% (p<0.05, at day 14) tumor growth inhibition in vivo when compared to the control group. The efficacy of AZ’7608 is enhanced by its combination with anti-EGFR antibody, showing tumor regression (82%, p<0.001). In addition, we performed pharmacodynamic studies to explore the relationship between efficacy and target/pathway modulation. These studies establish a clear relationship between depth and duration of inhibition of the phosphorylation of EGFR and anti-tumor efficacy.
The work presented herein shows a proof of concept for reversible phosphine oxide pyrazole inhibitors to target tumors harboring C797S. The emergence of the C797S EGFR mutation remains a key area of unmet need and warrants further efforts in drug discovery.
Citation Format: Nicolas Floch, M. Raymond V. Finlay, Ambra Bianco, Sue Bickerton, Nicola Colclough, Darren A. Cross, Emanuela M. Cuomo, Carine M. Guerot, David Hargreaves, Matthew J. Martin, Darren McKerrecher, Daniel J. O’Neill, Jonathan P. Orme, Amar Rahi, Paul D. Smith, Richard A. Ward. Evaluation of the therapeutic potential of phosphine oxide pyrazole inhibitors in tumors harboring EGFR C797S mutation [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4451.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Amar Rahi
- AstraZeneca, Cambridge, United Kingdom
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Sale MJ, Balmanno K, Saxena J, Ozono E, Wojdyla K, McIntyre RE, Gilley R, Woroniuk A, Howarth KD, Hughes G, Dry JR, Arends MJ, Caro P, Oxley D, Ashton S, Adams DJ, Saez-Rodriguez J, Smith PD, Cook SJ. MEK1/2 inhibitor withdrawal reverses acquired resistance driven by BRAF V600E amplification whereas KRAS G13D amplification promotes EMT-chemoresistance. Nat Commun 2019; 10:2030. [PMID: 31048689 PMCID: PMC6497655 DOI: 10.1038/s41467-019-09438-w] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 03/11/2019] [Indexed: 12/22/2022] Open
Abstract
Acquired resistance to MEK1/2 inhibitors (MEKi) arises through amplification of BRAFV600E or KRASG13D to reinstate ERK1/2 signalling. Here we show that BRAFV600E amplification and MEKi resistance are reversible following drug withdrawal. Cells with BRAFV600E amplification are addicted to MEKi to maintain a precise level of ERK1/2 signalling that is optimal for cell proliferation and survival, and tumour growth in vivo. Robust ERK1/2 activation following MEKi withdrawal drives a p57KIP2-dependent G1 cell cycle arrest and senescence or expression of NOXA and cell death, selecting against those cells with amplified BRAFV600E. p57KIP2 expression is required for loss of BRAFV600E amplification and reversal of MEKi resistance. Thus, BRAFV600E amplification confers a selective disadvantage during drug withdrawal, validating intermittent dosing to forestall resistance. In contrast, resistance driven by KRASG13D amplification is not reversible; rather ERK1/2 hyperactivation drives ZEB1-dependent epithelial-to-mesenchymal transition and chemoresistance, arguing strongly against the use of drug holidays in cases of KRASG13D amplification.
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Affiliation(s)
- Matthew J Sale
- Signalling Programme, The Babraham Institute, Babraham Research Campus, Cambridge, CB22 3AT, UK.
| | - Kathryn Balmanno
- Signalling Programme, The Babraham Institute, Babraham Research Campus, Cambridge, CB22 3AT, UK
| | - Jayeta Saxena
- Signalling Programme, The Babraham Institute, Babraham Research Campus, Cambridge, CB22 3AT, UK
| | - Eiko Ozono
- Signalling Programme, The Babraham Institute, Babraham Research Campus, Cambridge, CB22 3AT, UK
| | - Katarzyna Wojdyla
- Proteomics Facility, The Babraham Institute, Babraham Research Campus, Cambridge, CB22 3AT, UK
| | - Rebecca E McIntyre
- Experimental Cancer Genetics, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridgeshire, CB10 1SA, UK
| | - Rebecca Gilley
- Signalling Programme, The Babraham Institute, Babraham Research Campus, Cambridge, CB22 3AT, UK
| | - Anna Woroniuk
- Signalling Programme, The Babraham Institute, Babraham Research Campus, Cambridge, CB22 3AT, UK
| | - Karen D Howarth
- Hutchison-MRC Research Centre, Department of Pathology, University of Cambridge, Hills Road, Cambridge, CB2 0XZ, UK
| | - Gareth Hughes
- Oncology Bioscience, Innovative Medicines and Early Development Biotech Unit, AstraZeneca, CRUK Cambridge Institute, Robinson Way, Cambridge, CB2 0RE, UK
| | - Jonathan R Dry
- Oncology Bioscience, Innovative Medicines and Early Development Biotech Unit, AstraZeneca, 35 Gatehouse Drive, Waltham, MA, 02451, USA
| | - Mark J Arends
- Division of Pathology, Centre for Comparative Pathology, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XR, UK
| | - Pilar Caro
- Signalling Programme, The Babraham Institute, Babraham Research Campus, Cambridge, CB22 3AT, UK
| | - David Oxley
- Proteomics Facility, The Babraham Institute, Babraham Research Campus, Cambridge, CB22 3AT, UK
| | - Susan Ashton
- Oncology Bioscience, Innovative Medicines and Early Development Biotech Unit, AstraZeneca, Alderley Park, Macclesfield, SK10 4TG, UK
| | - David J Adams
- Experimental Cancer Genetics, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridgeshire, CB10 1SA, UK
| | - Julio Saez-Rodriguez
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Wellcome Genome Campus, Hinxton, Cambridgeshire, CB10 1SD, UK
| | - Paul D Smith
- Oncology Bioscience, Innovative Medicines and Early Development Biotech Unit, AstraZeneca, CRUK Cambridge Institute, Robinson Way, Cambridge, CB2 0RE, UK
| | - Simon J Cook
- Signalling Programme, The Babraham Institute, Babraham Research Campus, Cambridge, CB22 3AT, UK.
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Choi H, Deng J, Li S, Silk T, Dong L, Brea EJ, Redmond DC, Houghton S, Falik N, Boiarsky J, Zhong H, Akbay EA, Smith PD, Merghoub T, Wong KK, Wolchok JD. Pulsatile MEK inhibition improves anti-tumor immunity and T cell function in Kras mutant lung cancer. The Journal of Immunology 2019. [DOI: 10.4049/jimmunol.202.supp.134.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
KRAS is one of the most commonly identified driver oncogene in non-small cell lung cancer (NSCLC) and is commonly associated with disease refractory to current available modalities of treatment. Targeted therapy to inhibit MEK has shown promising tumor growth control in preclinical models, but is followed by quick rebound of tumor growth. Recently, immune checkpoint blockade has shown clinical activity by dis-inhibiting T cells that are suppressed in the tumor microenvironment. We sought to identify the most effective therapy for the treatment of KRAS mutant NSCLC patients by targeting cancer cells and activating infiltrating immune cells concurrently. We focused on studying the impact of pulsatile MEK inhibition on the immune microenvironment. We found that pulsatile MEK inhibition maintained T cell activation better than continuous treatment ex vivo and in vivo. Treatment with two different MEK inhibitors (selumetinib and trametinib) each resulted in higher CTLA-4 and PD-1 expression in tumor-infiltrating T cells using pulsatile treatment, compared to continuous treatment in Kras mutant lung cancer mice. In addition, the pulsatile schedule showed a superior anti-tumor effect and delayed drug resistance compared to the continuous schedule. Further, combination of pulsatile MEK inhibitor treatment and CTLA-4 blockade resulted in the longest survival of Kras tumor-bearing mice. Similar experiments in immune deficient mice confirmed that this prolonged survival is conferred by adaptive immunity. Our findings set the foundation for a combinatorial therapeutic strategy using pulsatile targeted therapy together with immunotherapy in patients to optimally enhance tumor apoptosis and promote immune response simultaneously.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Esra A Akbay
- 3University of Texas Southwestern Medical Center
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Nelson N, Lopez-Pelaez M, Palazon A, Poon E, De La Roche M, Barry S, Valge-Archer V, Wilkinson RW, Dovedi SJ, Smith PD. A cell-engineered system to assess tumor cell sensitivity to CD8 + T cell-mediated cytotoxicity. Oncoimmunology 2019; 8:1599635. [PMID: 31413906 PMCID: PMC6682348 DOI: 10.1080/2162402x.2019.1599635] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 02/08/2019] [Accepted: 03/18/2019] [Indexed: 01/23/2023] Open
Abstract
In vitro assays that evaluate CD8+ T cell-mediated cytotoxicity are important to aid in the development of novel therapeutic approaches to enhance anti-tumor immune responses. Here, we describe a novel cytotoxicity co-culture assay that circumvents the problem of highly variable allogeneic responses and obviates the constraints of HLA-restriction between effector and target cells. We show that this assay can be easily applied to a panel of tumor cell lines to provide additional insights into intrinsic drivers of sensitivity/resistance to T cell-mediated killing, and to evaluate the impact of targeted therapies on both tumor and T cell compartments.
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Affiliation(s)
- Nadine Nelson
- Bioscience, Oncology, IMED Biotech Unit, AstraZeneca, Cambridge, UK
| | | | | | | | - Maike De La Roche
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Simon Barry
- Bioscience, Oncology, IMED Biotech Unit, AstraZeneca, Cambridge, UK
| | | | | | | | - Paul D. Smith
- Bioscience, Oncology, IMED Biotech Unit, AstraZeneca, Cambridge, UK
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Richardson S, Feldstein D, McGinn T, Park LS, Khan S, Hess R, Smith PD, Mishuris RG, McCullagh L, Mann D. Live Usability Testing of Two Complex Clinical Decision Support Tools: Observational Study. JMIR Hum Factors 2019; 6:e12471. [PMID: 30985283 PMCID: PMC6487349 DOI: 10.2196/12471] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/10/2019] [Accepted: 01/30/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Potential of the electronic health records (EHR) and clinical decision support (CDS) systems to improve the practice of medicine has been tempered by poor design and the resulting burden they place on providers. CDS is rarely tested in the real clinical environment. As a result, many tools are hard to use, placing strain on providers and resulting in low adoption rates. The existing CDS usability literature relies primarily on expert opinion and provider feedback via survey. This is the first study to evaluate CDS usability and the provider-computer-patient interaction with complex CDS in the real clinical environment. OBJECTIVE This study aimed to further understand the barriers and facilitators of meaningful CDS usage within a real clinical context. METHODS This qualitative observational study was conducted with 3 primary care providers during 6 patient care sessions. In patients with the chief complaint of sore throat, a CDS tool built with the Centor Score was used to stratify the risk of group A Streptococcus pharyngitis. In patients with a chief complaint of cough or upper respiratory tract infection, a CDS tool built with the Heckerling Rule was used to stratify the risk of pneumonia. During usability testing, all human-computer interactions, including audio and continuous screen capture, were recorded using the Camtasia software. Participants' comments and interactions with the tool during clinical sessions and participant comments during a postsession brief interview were placed into coding categories and analyzed for generalizable themes. RESULTS In the 6 encounters observed, primary care providers toggled between addressing either the computer or the patient during the visit. Minimal time was spent listening to the patient without engaging the EHR. Participants mostly used the CDS tool with the patient, asking questions to populate the calculator and discussing the results of the risk assessment; they reported the ability to do this as the major benefit of the tool. All providers were interrupted during their use of the CDS tool by the need to refer to other sections of the chart. In half of the visits, patients' clinical symptoms challenged the applicability of the tool to calculate the risk of bacterial infection. Primary care providers rarely used the incorporated incentives for CDS usage, including progress notes and patient instructions. CONCLUSIONS Live usability testing of these CDS tools generated insights about their role in the patient-provider interaction. CDS may contribute to the interaction by being simultaneously viewed by the provider and patient. CDS can improve usability and lessen the strain it places on providers by being short, flexible, and customizable to unique provider workflow. A useful component of CDS is being as widely applicable as possible and ensuring that its functions represent the fastest way to perform a particular task.
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Affiliation(s)
- Safiya Richardson
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - David Feldstein
- University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Thomas McGinn
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Linda S Park
- University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Sundas Khan
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Rachel Hess
- School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Paul D Smith
- University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | | | - Lauren McCullagh
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Devin Mann
- New York University School of Medicine, New York, NY, United States
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Matusik M, Smith PD. A cross sectional study to ascertain the incidence and causes of failure of oxygen delivery via Hudson Mask™ during recovery after anaesthesia. Anaesth Intensive Care 2019; 47:96-97. [PMID: 30864470 DOI: 10.1177/0310057x18811728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Matthew Matusik
- 1 Department of Anaesthesia, St. Vincent's Hospital, Melbourne, Australia
| | - Paul D Smith
- 2 Department of Neurosurgery, St. Vincent's Hospital, Melbourne, Australia
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Mann D, Hess R, McGinn T, Mishuris R, Chokshi S, McCullagh L, Smith PD, Palmisano J, Richardson S, Feldstein DA. Adaptive design of a clinical decision support tool: What the impact on utilization rates means for future CDS research. Digit Health 2019; 5:2055207619827716. [PMID: 30792877 PMCID: PMC6376549 DOI: 10.1177/2055207619827716] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 01/10/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE We employed an agile, user-centered approach to the design of a clinical decision support tool in our prior integrated clinical prediction rule study, which achieved high adoption rates. To understand if applying this user-centered process to adapt clinical decision support tools is effective in improving the use of clinical prediction rules, we examined utilization rates of a clinical decision support tool adapted from the original integrated clinical prediction rule study tool to determine if applying this user-centered process to design yields enhanced utilization rates similar to the integrated clinical prediction rule study. MATERIALS & METHODS: We conducted pre-deployment usability testing and semi-structured group interviews at 6 months post-deployment with 75 providers at 14 intervention clinics across the two sites to collect user feedback. Qualitative data analysis is bifurcated into immediate and delayed stages; we reported on immediate-stage findings from real-time field notes used to generate a set of rapid, pragmatic recommendations for iterative refinement. Monthly utilization rates were calculated and examined over 12 months. RESULTS We hypothesized a well-validated, user-centered clinical decision support tool would lead to relatively high adoption rates. Then 6 months post-deployment, integrated clinical prediction rule study tool utilization rates were substantially lower than anticipated based on the original integrated clinical prediction rule study trial (68%) at 17% (Health System A) and 5% (Health System B). User feedback at 6 months resulted in recommendations for tool refinement, which were incorporated when possible into tool design; however, utilization rates at 12 months post-deployment remained low at 14% and 4% respectively. DISCUSSION Although valuable, findings demonstrate the limitations of a user-centered approach given the complexity of clinical decision support. CONCLUSION Strategies for addressing persistent external factors impacting clinical decision support adoption should be considered in addition to the user-centered design and implementation of clinical decision support.
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Affiliation(s)
- Devin Mann
- Department of Population Health, New York University School of Medicine, United States of America
| | - Rachel Hess
- Department of Population Sciences, University of Utah School of Medicine, United States of America
| | - Thomas McGinn
- Division of General Internal Medicine, Hofstra Northwell School of Medicine, United States of America
| | - Rebecca Mishuris
- Department of Medicine, Boston University, United States of America
| | - Sara Chokshi
- Department of Population Health, New York University School of Medicine, United States of America
| | - Lauren McCullagh
- Division of General Internal Medicine, Hofstra Northwell School of Medicine, United States of America
| | - Paul D Smith
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, United States of America
| | - Joseph Palmisano
- Department of Medicine, Boston University, United States of America
| | - Safiya Richardson
- Division of General Internal Medicine, Hofstra Northwell School of Medicine, United States of America
| | - David A Feldstein
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, United States of America
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Shiyanbola OO, Walbrandt Pigarelli DL, Unni EJ, Smith PD, Maurer MA, Huang YM. Design and rationale of a mixed methods randomized control trial: ADdressing Health literacy, bEliefs, adheRence and self-Efficacy (ADHERE) program to improve diabetes outcomes. Contemp Clin Trials Commun 2019; 14:100326. [PMID: 30705995 PMCID: PMC6348197 DOI: 10.1016/j.conctc.2019.100326] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/09/2019] [Accepted: 01/12/2019] [Indexed: 11/16/2022] Open
Abstract
Background Improving medication adherence is one of the most effective approaches to improving the health outcomes of patients with diabetes. To date, enhancing diabetes medication adherence has occurred by improving diabetes-related knowledge. Unfortunately, behavior change often does not follow knowledge change. Enhancing communication between patients and healthcare professionals through addressing health literacy-related psychosocial attributes is critical. Objective Examine whether a patient-centered intervention augmenting usual care with a health literacy-psychosocial support intervention will improve medication adherence for patients with diabetes, compared to usual care. Methods This study is a randomized controlled trial with an intervention mixed methods design. Fifty participants being enrolled are English-speaking, 18–80 years old with diagnosed diabetes, take at least one diabetes medication, have low diabetes medication adherence (proportion of days covered less than 80% or based on clinical notes), and have poor diabetes control (hemoglobin A1c of ≥8%). Participants will be allocated to either a control group receiving usual care (n = 25) or an intervention group (n = 25) receiving usual care and a 6-session intervention focusing on the modifiable psychosocial factors that may influence medication adherence. A questionnaire will be administered at baseline and at the end of the intervention to all participants to assess the effectiveness of the intervention. Fifteen participants from the intervention group will be interviewed to explore participants’ experiences and perceptions of the intervention processes and outcomes. Conclusions The trial will examine if a patient-centered intervention that addresses patients’ health literacy and focuses on modifiable psychosocial factors will improve medication adherence among patients with diabetes.
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Affiliation(s)
- Olayinka O Shiyanbola
- Division of Social and Administrative Sciences, School of Pharmacy, University of Wisconsin-Madison, WI, USA
| | | | - Elizabeth J Unni
- Department of Pharmaceutical Sciences, College of Pharmacy, Roseman University of Health Sciences, Utah, USA
| | - Paul D Smith
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, WI, USA
| | - Martha A Maurer
- Sonderegger Research Center, School of Pharmacy, University of Wisconsin-Madison, WI, USA
| | - Yen-Ming Huang
- Division of Social and Administrative Sciences, School of Pharmacy, University of Wisconsin-Madison, WI, USA
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Smith PD, Martin B, Chewning B, Hafez S, Leege E, Renken J, Smedley Ramos R. Improving health care communication for caregivers: A pilot study. Gerontol Geriatr Educ 2018; 39:433-444. [PMID: 27379507 PMCID: PMC6113114 DOI: 10.1080/02701960.2016.1188810] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
With the growing older adult population, there will also be more informal caregivers assisting friends and family with their health care. With the increasing complexity of health care, improved caregiver communication skills have the potential to reduce caregiver burden and frustration and improve care recipient health. The primary goal of this project was to develop and refine the content and teaching methods of a small-group behavioral change program to improve communication between caregivers of older adults and health care professionals. The authors developed the Care Talks program for improving communication between caregivers and health care professionals. They conducted a prospective cohort feasibility study of the intervention to assess caregiver communication confidence at baseline and one month postintervention. Six participants were enrolled. Of the 15 participants who answered the question, 15 (100%) would recommend this program to a friend. There was significant improvement in a 10-question composite of communication confidence pre/post scores from 74.1 to 79.6 p = .03. This small-group behavioral change intervention significantly improved communication confidence for this sample of caregivers. Further research is needed to determine the long-term effects of this program on caregivers and care recipients.
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Affiliation(s)
- Paul D Smith
- a Department of Family Medicine , University of Wisconsin-Madison , Madison , Wisconsin USA
| | - Beth Martin
- b School of Pharmacy , University of Wisconsin-Madison , Madison , Wisconsin USA
| | - Betty Chewning
- b School of Pharmacy , University of Wisconsin-Madison , Madison , Wisconsin USA
| | - Stephanie Hafez
- c Aging and Disability Resource Center of Green County , Monroe , Wisconsin USA
| | - Erin Leege
- d Wisconsin Research and Education Network , Madison , Wisconsin USA
| | - Jill Renken
- e Community-Academic Aging Research Network , Madison , Wisconsin USA
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